Treiman D M
University of California, Los Angeles, School of Medicine, CA 90095, USA.
Baillieres Clin Neurol. 1996 Dec;5(4):821-39.
Status epilepticus is a condition in which multiple epileptic seizures occur without complete recovery from the physiological effects of one seizure before another seizure occurs. There are as many types of SE as there are kinds of epileptic seizures. Generalized convulsive status epilepticus initially presents with repeated generalized convulsions without full recovery of consciousness between seizures. If untreated or undertreated, the convulsive activity becomes progressively subtle and is accompanied by a predictable series of progressive EEG changes. Non-convulsive SE refers to complex partial SE or absence SE, both of which exhibit an epileptic twilight state of altered contact with the environment. In simple partial SE there is no impairment of consciousness, and the behavioural changes reflect focal ictal discharges confined to one area of the cortex. There are between 65,000 and 150,000 cases of the SE in the US each year. Both acute and remote cerebral insults can cause SE, as can severe systemic disease that causes SE secondary to a toxic-metabolic encephalopathy. Mortality is high, but is largely a reflection of underlying aetiology when SE is treated appropriately and aggressively. Treatment is focused on terminating ongoing seizure activity as quickly as possible, both because the longer SE persists the more likely permanent neuronal damage will ensure and also because of strong evidence that the longer SE persists the more refractory to treatment it will be. Currently the most commonly accepted treatment protocol involves rapid initiation of therapy with intravenous lorazepam (0.1 mg/kg), followed, if necessary, by 20 mg/kg of phenytoin, followed, if necessary, by 20 mg/kg of phenobarbital. However, some neurologists still use intravenous diazepam (because of its more rapid antistatus effect) followed by phenytoin. New experimental data in the rat suggest that phenytoin followed by diazepam may be more effective, but this order of administration still has to tested in properly designed clinical trials.
癫痫持续状态是一种在一次癫痫发作的生理效应尚未完全恢复之前就发生多次癫痫发作的病症。癫痫持续状态的类型与癫痫发作的类型一样多。全面性惊厥性癫痫持续状态最初表现为反复的全面性惊厥，发作之间意识未完全恢复。如果未得到治疗或治疗不足，惊厥活动会逐渐变得不明显，并伴有一系列可预测的脑电图渐进性变化。非惊厥性癫痫持续状态是指复杂部分性癫痫持续状态或失神性癫痫持续状态，两者均表现为与环境接触改变的癫痫朦胧状态。在简单部分性癫痫持续状态中，意识没有受损，行为变化反映了局限于皮质一个区域的局灶性发作期放电。在美国，每年有65,000至150,000例癫痫持续状态病例。急性和远期脑损伤均可导致癫痫持续状态，严重的全身性疾病继发中毒代谢性脑病也可导致癫痫持续状态。死亡率很高，但在对癫痫持续状态进行适当积极治疗时，很大程度上反映了潜在病因。治疗的重点是尽快终止正在进行的癫痫发作活动，这是因为癫痫持续状态持续的时间越长，永久性神经元损伤的可能性就越大，而且有强有力的证据表明，癫痫持续状态持续的时间越长，治疗就越难。目前最普遍接受的治疗方案包括迅速开始静脉注射劳拉西泮（0.1mg/kg）治疗，如有必要，随后给予20mg/kg苯妥英钠，如有必要，再给予20mg/kg苯巴比妥。然而，一些神经科医生仍使用静脉注射地西泮（因其抗癫痫持续状态作用更快），随后给予苯妥英钠。大鼠的新实验数据表明，先给予苯妥英钠后给予地西泮可能更有效，但这种给药顺序仍需在设计合理的临床试验中进行检验。
