Department of Neurology, Liaocheng People's Hospital, Liaocheng, Shandong Province, P.R. China.
Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong Province, P.R. China.
Medicine (Baltimore). 2023 Sep 29;102(39):e35233. doi: 10.1097/MD.0000000000035233.
Super-refractory status epilepticus is a serious illness with high morbidity and mortality, which is defined as an SE that continues or recurs 24 hours or more after the onset of anesthesia. Anesthetic agents can be either pro-convulsant or anticonvulsant or both.
Epilepsy occurred at the age of 3 years. At the age of 4 years, generalized tonic-clonic seizure occurred for the first time. The patient was hospitalized at the age of 27 and 28 years for treating status epilepticus. At the age of 33 years, antiepileptic drugs were stopped due to poor appetite. In an early morning, the patient was found delirious with reduced speech.
Occasionally, the patient blinked his eyelids, or deflected his eyeballs to 1 side. When propofol was lowered to 10 mL/H, the epileptic wave reduced obviously. Afterwards, the patient opened his eyes autonomously and his consciousness gradually recovered. The patient could answer questions, and the limbs had voluntary movements. The patient breathing also gradually recovered, and his urine gradually returned to pale yellow from green. After anesthetic was stopped for 10 days, the patient lost his consciousness again. The patient eyes turned upward frequently, which was relieved in 1 to 2 seconds with an attack once every 2 to 5 minutes.
Clonazepam was gradually reduced to 2 mg qn, and the patient gradually woke up during this process. The patient was also treated with levetiracetam 1.5 g bid, oxcarbazepine 0.6 g bid, topiramate 50 mg bid and valproate 0.4 g tid.
After 1 month follow-up, status epilepticus did not appear again.
Propofol aggravated the tonic seizures. As tonic seizures occur during natural sleep and after sleep induced by various narcotic drugs, the decrease of consciousness level induced by excessive sedation of narcotic drugs has been suggested as the reason for poor seizure control.
难治性癫痫持续状态是一种发病率和死亡率都很高的严重疾病，定义为麻醉后 24 小时或更长时间持续或复发的癫痫持续状态。麻醉剂既可以是促惊厥剂，也可以是抗惊厥剂，或者两者兼而有之。
3 岁时出现癫痫。4 岁时首次出现全面强直阵挛发作。患者分别于 27 岁和 28 岁时因癫痫持续状态住院治疗。33 岁时，由于食欲不振，停止服用抗癫痫药物。一天清晨，患者被发现神志不清，言语减少。
偶尔，患者会眨眼，或眼球偏向一侧。当丙泊酚降至 10ml/h 时，癫痫波明显减少。之后，患者自主睁眼，意识逐渐恢复。患者可以回答问题，四肢有自主运动。患者呼吸也逐渐恢复，尿液逐渐从绿色变为浅黄色。停止麻醉 10 天后，患者再次失去意识。患者眼睛频繁上翻，每次发作持续 1 到 2 秒，每 2 到 5 分钟发作一次。
逐渐将氯硝西泮减少至 2mg qn，在此过程中患者逐渐清醒。同时，患者还接受了左乙拉西坦 1.5g bid、奥卡西平 0.6g bid、托吡酯 50mg bid 和丙戊酸钠 0.4g tid 治疗。
随访 1 个月后，未再出现癫痫持续状态。
丙泊酚加重了强直发作。由于强直发作发生在自然睡眠期间和各种麻醉药物诱导的睡眠之后，过量镇静麻醉药物导致的意识水平下降被认为是控制不佳的原因。
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