Leitinger M, Bosque-Varela P, Kuchukhidze G, Leitner U, Höfler J, Kalss G, Rossini F, Pilz G, Novak H, Mauritz M, Poppert K, Toma A, Trinka E
Department of Neurology, Neurocritical Care, and Neurorehabilitation, Member of European Reference Network EpiCARE, Centre for Cognitive Neuroscience, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria.
Neuroscience Institute, Centre for Cognitive Neuroscience, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria.
Epileptic Disord. 2025 Aug;27(4):530-549. doi: 10.1002/epd2.70033. Epub 2025 Jun 18.
Status epilepticus (SE) can be regarded as the most severe expression of seizure activity characterized by a low probability of spontaneous cessation and mechanisms leading to metabolic and inflammatory derangements with increased risk of brain damage, alterations of neural networks, and potentially life-threatening systemic complications. Time-based criteria are fundamental in diagnosing SE as response to treatment and outcomes worsen with increasing duration in terms of neurological impairment and mortality. Classification of status epilepticus includes four axes: semiology, EEG correlates, etiology, and age. Semiology, especially when evolving from SE with prominent motor phenomena (SE-PM) to nonconvulsive status epilepticus (NCSE) with impaired consciousness, is associated with drug resistance and poor prognosis. The Salzburg EEG criteria define four subcategories of NCSE. The umbrella term ictal-interictal continuum (IIC) includes a wide spectrum of EEG changes ranging from almost non-epileptic situations to conditions that just fail to fulfill the criteria of NCSE. From a pathophysiologic point of view, EEG patterns on the IIC might be generated by both the underlying etiology and the superimposed hypersynchronous epileptic activity. It is impossible to disentangle their relative contributions by visual inspection of the EEG. However, it is essential to identify the contribution of ictal activity in an individual patient as it may be amenable to treatment with antiseizure medication (ASM). The main approach is to perform a diagnostic intravenous ASM trial (diagnostic IV-ASM trial) during EEG recording and to assess for both EEG and clinical response. Furthermore, CT- and MRI-perfusion studies help to clarify the diagnosis. Early and consequent treatment is necessary to minimize the total time spent in status, also called seizure burden. This educational review focuses on the diagnosis of status epilepticus in children and adults, excluding neonatal status.
癫痫持续状态（SE）可被视为癫痫发作活动的最严重表现，其特征是自发停止的可能性低，且存在导致代谢和炎症紊乱的机制，增加了脑损伤、神经网络改变以及潜在危及生命的全身并发症的风险。基于时间的标准对于诊断SE至关重要，因为随着发作持续时间的增加，治疗反应和预后在神经功能损害和死亡率方面会恶化。癫痫持续状态的分类包括四个轴：症状学、脑电图相关性、病因和年龄。症状学，尤其是当从具有明显运动现象的SE（SE-PM）演变为意识受损的非惊厥性癫痫持续状态（NCSE）时，与耐药性和不良预后相关。萨尔茨堡脑电图标准定义了NCSE的四个亚类。总括术语发作-发作间期连续体（IIC）包括从几乎非癫痫情况到仅未达到NCSE标准的一系列脑电图变化。从病理生理学角度来看，IIC上的脑电图模式可能由潜在病因和叠加的超同步癫痫活动共同产生。通过目视检查脑电图无法区分它们的相对贡献。然而，确定个体患者发作活动中的贡献至关重要，因为它可能适合用抗癫痫药物（ASM）治疗。主要方法是在脑电图记录期间进行诊断性静脉注射ASM试验（诊断性静脉注射ASM试验），并评估脑电图和临床反应。此外，CT和MRI灌注研究有助于明确诊断。早期和持续治疗对于将处于癫痫持续状态的总时间（也称为发作负担）降至最低是必要的。本教育综述重点关注儿童和成人癫痫持续状态的诊断，不包括新生儿癫痫持续状态。
