Gettings Jennifer V, Mohammad Alizadeh Chafjiri Fatemeh, Patel Archana A, Shorvon Simon, Goodkin Howard P, Loddenkemper Tobias
Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Guilan University of Medical Sciences, Rasht, Iran.
Lancet Neurol. 2025 Jan;24(1):65-76. doi: 10.1016/S1474-4422(24)00430-7. Epub 2024 Dec 2.
Status epilepticus is a common neurological emergency that is characterised by prolonged or recurrent seizures without recovery between episodes and associated with substantial morbidity and mortality. Prompt recognition and targeted therapy can reduce the risk of complications and death associated with status epilepticus, thereby improving outcomes. The most recent International League Against Epilepsy definition considers two important timepoints in status epilepticus: first, when the seizure does not self-terminate; and second, when the seizure can have long-term consequences, including neuronal injury. Recent advances in our understanding of the pathophysiology of status epilepticus indicate that changes in neurotransmission as status epilepticus progresses can increase excitatory seizure-facilitating and decrease inhibitory seizure-terminating mechanisms at a cellular level. Effective clinical management requires rapid initiation of supportive measures, assessment of the cause of the seizure, and first-line treatment with benzodiazepines. If status epilepticus continues, management should entail second-line and third-line treatment agents, supportive EEG monitoring, and admission to an intensive care unit. Future research to study early seizure detection, rescue protocols and medications, rapid treatment escalation, and integration of fundamental scientific and clinical evidence into clinical practice could shorten seizure duration and reduce associated complications. Furthermore, improved recognition, education, and treatment in patients who are at risk might help to prevent status epilepticus, particularly for patients living in low-income and middle-income countries.
癫痫持续状态是一种常见的神经系统急症，其特征为发作持续时间延长或反复发作且发作期间无恢复，并伴有较高的发病率和死亡率。及时识别并进行针对性治疗可降低与癫痫持续状态相关的并发症和死亡风险，从而改善预后。国际抗癫痫联盟的最新定义考虑了癫痫持续状态中的两个重要时间点：第一，发作未自行终止时；第二，发作可能产生长期后果（包括神经元损伤）时。我们对癫痫持续状态病理生理学认识的最新进展表明，随着癫痫持续状态的进展，神经传递的变化可在细胞水平上增加促进癫痫发作的兴奋性机制，并减少终止癫痫发作的抑制性机制。有效的临床管理需要迅速启动支持措施、评估癫痫发作的原因，并使用苯二氮䓬类药物进行一线治疗。如果癫痫持续状态仍在继续，管理应包括二线和三线治疗药物、支持性脑电图监测，并收入重症监护病房。未来研究早期癫痫检测、抢救方案和药物、快速治疗升级以及将基础科学和临床证据整合到临床实践中，可能会缩短癫痫发作持续时间并减少相关并发症。此外，改善对高危患者的识别、教育和治疗可能有助于预防癫痫持续状态，特别是对于生活在低收入和中等收入国家的患者。
