Department of Neurology, Division of Neurocritical Care, University of Florida College of Medicine, Gainesville, FL 32611, USA; Department of Neurology, Yale University School of Medicine, New Haven, CT 06520, USA; Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA.
Department of Neurology, Division of Neurocritical Care, University of Florida College of Medicine, Gainesville, FL 32611, USA.
Epilepsy Behav. 2024 Nov;160:110082. doi: 10.1016/j.yebeh.2024.110082. Epub 2024 Oct 10.
The outcomes of patients who experience status epilepticus during the post-cardiac arrest period, or post-anoxic status epilepticus (PASE), remain dismal despite advances in resuscitation. The combination of therapeutic nihilism and the refractoriness of seizures in a setting where pessimistic prognostic impressions prevail is likely the main driver of such poor outcomes. The resulting pervasive vicious cycle perpetuates this knowledge gap, whereby hypoxic-ischemic insults as the etiology for seizures remain a ubiquitous exclusion criterion for clinal trials in status epilepticus. Effective therapies targeting hyperexcitability resulting from hypoxic-ischemic brain injury are urgently needed. Early inhibition of gamma-aminobutyric acid (GABA) transaminase with vigabatrin holds potential as an effective adjunctive therapy for PASE. This scientific premise is based on the resulting halted GABA catabolism thereby promoting synergistic augmentation of GABAergic pathway when used in combination with positive GABAergic allosteric modulators. This paper is based on a lecture presented at the 9th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures, in London 8-10 April 2024.
尽管在复苏方面取得了进展，但经历心脏骤停后或缺氧性癫痫持续状态（PASE）期间癫痫持续状态的患者的结局仍然不容乐观。在这种预后不佳的情况下，治疗上的虚无主义和癫痫的难治性可能是导致这种不良结局的主要原因。由此产生的普遍恶性循环加剧了这一知识差距，即缺氧缺血性损伤引起的癫痫发作仍然是癫痫持续状态临床试验的普遍排除标准。迫切需要针对缺氧缺血性脑损伤引起的过度兴奋的有效治疗方法。早期使用 vigabatrin 抑制γ-氨基丁酸（GABA）转氨酶可能是 PASE 的一种有效辅助治疗方法。这一科学前提是基于 GABA 分解代谢的停止，从而在与阳性 GABA 变构调节剂联合使用时促进 GABA 能途径的协同增强。本文基于 2024 年 4 月 8 日至 10 日在伦敦举行的第九届伦敦-因斯布鲁克癫痫持续状态和急性发作学术研讨会上的一次演讲。
