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[儿童惊厥性癫痫持续状态的管理]

[Management of convulsive status epilepticus in childhood].

作者信息

Glatter Sarah, Cardona Francesco, Trinka Eugen, Leitinger Markus, Feucht Martha

机构信息

Department of Pediatrics and Adolescent Medicine, Center for Rare and Complex Childhood Onset Epilepsies, Member of ERN EpiCARE, Medical University Vienna, Vienna, Austria.

Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Vienna, Austria.

出版信息

Wien Klin Wochenschr. 2025 Sep;137(Suppl 7):233-241. doi: 10.1007/s00508-025-02570-2. Epub 2025 Sep 16.

DOI:10.1007/s00508-025-02570-2
PMID:40956433
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12441103/
Abstract

Convulsive status epilepticus (CSE) is one of the most common pediatric emergencies. The duration of CSE is critical, whereby with increasing duration the cessation of CSE becomes more difficult or less probable and mortality as well as short and long-term complications increase exponentially. Prompt diagnostics and treatment of pediatric CSE (PCSE) are therefore essential. In contrast to adulthood, updated generally accepted guidelines for a structured approach do not yet exist. Based on current evidence the Austrian EpiCARE centers of the Department of Pediatrics at the Medical University Vienna in close cooperation with the Department of Neurology at the Christian Doppler University Hospital in Salzburg developed a continuous documentation process beginning with the time when the young patient was last seen free of symptoms, through prehospital interventions up to admission in the emergency outpatient department and further up to the admission in the pediatric intermediate care (IMC) or intensive care units (PIC). In addition, a pocket card with detailed information on structured specific diagnostics and treatment was developed, which is aimed at guaranteeing rapid adequate measures independent of the staffing by medical personnel (e.g., during night shifts or at weekends). The concept presented here is aimed at sensitizing prehospital and emergency physicians as well as pediatricians at local initial admission centers to further harmonize in-/inter-house treatment standards with the intention of preventing refractory or superrefractory PCSE and possible resulting complications.

摘要

惊厥性癫痫持续状态(CSE)是最常见的儿科急症之一。CSE的持续时间至关重要,随着持续时间的增加,CSE的终止变得更加困难或可能性降低,死亡率以及短期和长期并发症呈指数级增加。因此,及时诊断和治疗儿科CSE(PCSE)至关重要。与成人情况不同,目前尚无针对结构化方法的更新的普遍接受的指南。基于当前证据,维也纳医科大学儿科学系的奥地利EpiCARE中心与萨尔茨堡基督教多普勒大学医院的神经科密切合作,制定了一个连续记录流程,从最后一次见到年轻患者无症状的时间开始,涵盖院前干预措施,直至在急诊门诊部入院,再到儿科中级护理(IMC)或重症监护病房(PIC)入院。此外,还制作了一张袖珍卡片,上面有关于结构化特定诊断和治疗的详细信息,旨在确保无论医务人员配备情况如何(例如,在夜班或周末)都能迅速采取适当措施。这里提出的概念旨在提高院前和急诊医生以及当地初始收治中心的儿科医生的认识,以进一步协调院内/院间治疗标准,防止难治性或超难治性PCSE以及可能由此产生的并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c4e8/12441103/495386aa3357/508_2025_2570_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c4e8/12441103/77886b879378/508_2025_2570_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c4e8/12441103/bc2218b939cd/508_2025_2570_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c4e8/12441103/c7de0dcf9260/508_2025_2570_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c4e8/12441103/495386aa3357/508_2025_2570_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c4e8/12441103/77886b879378/508_2025_2570_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c4e8/12441103/bc2218b939cd/508_2025_2570_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c4e8/12441103/c7de0dcf9260/508_2025_2570_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c4e8/12441103/495386aa3357/508_2025_2570_Fig4_HTML.jpg

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本文引用的文献

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Treating seizures faster: The Quality Improvement in Time to Treat Status Epilepticus (QuITT-SE) multicenter randomized stepped wedge clinical trial protocol.更快治疗癫痫发作:治疗癫痫持续状态时间的质量改进(QuITT-SE)多中心随机阶梯楔形临床试验方案。
Contemp Clin Trials. 2025 Apr;151:107831. doi: 10.1016/j.cct.2025.107831. Epub 2025 Feb 8.
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Tenets of timing: An evidence based comprehensive review on time-lag in the management of pediatric status epilepticus and its effect on clinical outcomes.
Epilepsy Res. 2025 Feb;210:107518. doi: 10.1016/j.eplepsyres.2025.107518. Epub 2025 Jan 31.
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First Seizures, Acute Repetitive Seizures, and Status Epilepticus.首次发作、急性反复性发作和癫痫持续状态
Continuum (Minneap Minn). 2025 Feb 1;31(1):95-124. doi: 10.1212/cont.0000000000001530.
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The electroencephalogram in the diagnosis and classification of status epilepticus: a practical guide.脑电图在癫痫持续状态的诊断与分类中的应用:实用指南
Pract Neurol. 2025 Sep 12;25(5):396-410. doi: 10.1136/pn-2024-004336.
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The Prognostic Factors in Children With Status Epilepticus and Status Epilepticus Severity Score Scales.癫痫持续状态患儿的预后因素及癫痫持续状态严重程度评分量表
Behav Neurol. 2025 Jan 17;2025:6660355. doi: 10.1155/bn/6660355. eCollection 2025.
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New onset refractory status epilepticus: Long-term outcomes beyond seizures.新发难治性癫痫持续状态:癫痫发作之外的长期预后
Epilepsia. 2025 Apr;66(4):988-1005. doi: 10.1111/epi.18267. Epub 2025 Jan 18.
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Rapid response electroencephalography decreases time to seizure diagnosis in pediatric acute care patients.快速反应脑电图缩短了儿科急症患者癫痫发作的诊断时间。
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