难治性癫痫持续办状态的预后及处理.pptVIP

难治性癫痫持续状态 的预后及处理 四川省医学科学院·四川省人民医院 神经内科 孙红斌 2012-11 现状 癫痫持续状态是神经内科的急重症，多数国家癫痫持续状态均需进入NICU进行处理，经过适当的药物治疗和病因治疗，近80%病例均可获得满意的疗效。生命体征稳定，神经元得到保护，脑电图痫样放电停止，并发症得到良好控制。 但仍有9-22%的病例癫痫发作和并发症难以控制，并成为难治性癫痫持续状态( refractory status epilepticus， RSE)。 诊 断 二种以上药物治疗维持一小时以上，未能有效控制。 *Jan Novy, yGiancarlo Logroscino, Refractory status epilepticus: A prospective observational study。 Epilepsia, 2010，51(2):251–256 Status epilepticus (SE) that is resistant to two antiepileptic compounds is defined as refractory status epilepticus (RSE). In the few available retrospective studies, estimated RSE frequency is between 31% and 43% of patients presenting an SE episode; almost all seem to require a coma induction for treatment. We prospectively assessed RSE frequency, clinical predictors, and outcome in a tertiary clinical setting. *Jan Novy, yGiancarlo Logroscino, Refractory status epilepticus: A prospective observational study。 Epilepsia, 2010，51(2):251–256 Twenty-nine of 128 SE episodes (22.6%) were refractory to first- and second-line antiepileptic treatments. Severity of consciousness impairment and de novo episodes were independent predictors of RSE. RSE showed a worse outcome than non-RSE (39% vs. 11% for mortality; 21% vs. 63% for return to baseline clinical conditions). Only 12 patients with RSE (41%) required coma induction for treatment. 非惊厥性癫痫持续状态（NCSE）长程视频脑电可明显提高诊断率和监测治疗效果 Eric J. Ericson, Elizabeth E. Gerard，Aphasic status epilepticus: Electroclinical correlation，Epilepsia, 52(8):1452–1458, 2011 All nine patients were right-handed with subacute or chronic left hemispheric lesions on magnetic resonance imaging (MRI). All patients had mixed aphasia, three presenting with persistent aphasia from onset and six with episodic speech impairment, which became persistent in five of the six. The initial 30-min EEG demonstrated electrographic seizure in only five patients (56%), despite the presence of aphasia during the recording. Left hemispheric periodic lateralized epilept