Willmore L J
Department of Neurology, Texas Comprehensive Epilepsy Program, University of Texas Medical School, Houston, USA.
Neurology. 1998 Nov;51(5 Suppl 4):S34-8. doi: 10.1212/wnl.51.5_suppl_4.s34.
Patients experiencing a first seizure need a careful history and examination to confirm that the presenting seizure is truly the initial event and to identify other possible risk factors for recurrence. The decision of whether to start therapy should be made by the clinician and a fully informed patient. Status epilepticus presents in several forms, with generalized convulsive status epilepticus (GCSE) being the most dramatic. Management of GCSE requires life support and monitoring measures as well as timely administration of antiepileptic drugs (AEDs) to terminate the seizure and reduce the risks for morbidity and mortality. Benzodiazepines, phenytoin, and phenobarbital can all be used to treat GCSE. Clinicians need to be familiar with the dosage and administration, adverse events, time to onset, and duration of action of these drugs. Should seizures continue or recur despite AED administration, induction of coma with pentobarbital may be considered. This must be done with continuous EEG and other physiologic monitoring in an intensive care unit. Additional assessment of the patient who has experienced GCSE focuses on identification of the underlying cause.
首次发作的患者需要详细的病史询问和体格检查，以确认此次发作确实是首次发作事件，并识别其他可能的复发风险因素。是否开始治疗的决定应由临床医生和充分知情的患者共同做出。癫痫持续状态有多种形式，其中全身惊厥性癫痫持续状态（GCSE）最为严重。GCSE的治疗需要生命支持和监测措施，以及及时给予抗癫痫药物（AEDs）以终止发作并降低发病和死亡风险。苯二氮䓬类药物、苯妥英和苯巴比妥均可用于治疗GCSE。临床医生需要熟悉这些药物的剂量和用法、不良事件、起效时间和作用持续时间。如果尽管使用了AEDs癫痫仍持续或复发，可以考虑用戊巴比妥诱导昏迷。这必须在重症监护病房进行持续脑电图和其他生理监测的情况下进行。对经历过GCSE的患者的进一步评估重点在于识别潜在病因。
