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1、,四叫升等路回闻么路Sichuan Academy of Medical Sciences Sichuan Provincial Peoples Hospital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2019-11,川有骨學酐謦院川有人氏骨院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(refractorystatus
2、epilepticus,Rse),诊断幽川有骨學酐謦院川有人氏骨院二种以上药物治疗维持一小时以上,未能有效控制。,川有骨學酐謦院川有人氏骨院Status epilepticus(SE)that is resistant totwo antiepileptic compounds is defined asrefractory status epilepticus(RSE)In the few available retrospective studiesestimated RSe frequency is between 31%and 43%of patients presenting an
3、SEepisode;almost all seem to require a comainduction for treatmentWe prospectively assessed RSE frequency,clinical predictors,and outcome in atertiary clinical setting*Jan Novy,y Giancarlo Logroscino,Refractory status epilepticus:A prospectiveobservational study.Epilepsia,2019,51(2):251-256,川有骨學酐謦院川
4、有人氏骨院Twenty-nine of 128 SE episodes(22.6%)antiepileptic treatments Severity of newere refractory to first-and second-lilconsciousness impairment and de novoepisodes were independent predictors ofRSERSE showed a worse outcome than non-RSE(39%VS.11%for mortality:21%Vs63%for return to baseline clinical
5、conditions).Only 12 patients with RSE(41%)required coma induction fortreatmental study.Epilepsia,2019,51(2):251-256,川有骨學酐謦院川有人氏骨院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,川有骨學酐謦院川有人氏骨院All nine patients were right-handed with subacuteor chronic left hemispheric lesions on magneticresonance imaging(MRDAll
6、 patients had mixed aphasia,three presentingwith persistent aphasia from onset and six withepisodic speech impairment,which becamepersistent in five of the sixThe initial 30-min EEG demonstrated electrographicseizure in only five patients(56%),despite thepresence of aphasia during the recordingLeft
7、hemispheriodic lateralized epileptiformdischarges(Pleds)were seen in two patients,andleft hemispheric slowing in two patients.,川有骨學酐謦院川有人氏骨院Continuous video-EEG monitoring confirmedelectrographic seizure activity in all nine patientsPeak electrographic seizure frequency varied fromcontinuous to once
8、 every 2h and was not associatedwith fluctuations in the speech deficit.EEG seizures resolved abruptly in three patients andgradually over up to 4 days in six patientsClinical improvement was de layed in eight of thenine patients,and four patients retained someaphasia at discharge,2-4 days after EEG
9、 seizureresolutionERIC ERICSON,ELIZABETH E.GERARD APHASIC STATUS EPILEPTICUS:ELECTROCLINICAL CORRELATION,EPILEPSIA,52(8):1452-1458,2019,川有骨學酐謦院川有人氏骨院Standard eeg is sensitive for detection ofabnormalities in the dominanthemisphere in patients with AsEH。wever,continuous eEG is necessary toconfirm the
10、 diagnosis and monitortreatment,since clinical symptoms do notcorrelate with electrographic seizureactivity and do not provide sufficientinformation to guide treatment decisions.C)EricJ.Ericson,ElizabethEGerard,Aphasic status epilepticus:Electroclinicalcorrelation,Epilepsia,52(8):1452-1458,2019,预后川有
11、骨學酐謦院川有人氏骨院Table I.Etiologies in episod es ofrefractoryand nonrefractory status epilepticusRefractory Nonrefractory p-value TestAcute symptomatic19(655%)59(5963%)06672Remote symptomatic 5(7.2)17(17.26)Progres sive symptomatic 4(13.87)15(15.2%6)Cryptogenic/idiopathic I(3.4%0)8(8.18Potentially fatal etiology 20(6%)45(45.5%)0.034 xBold values indicate significant resultsational study,Epilepsia,51(2):251-256,
