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1、難治性癲癇持續(xù)狀態(tài)的預(yù)后及處理四川省醫(yī)學(xué)科學(xué)院·四川省人民醫(yī)院神經(jīng)內(nèi)科孫紅斌2012-11現(xiàn)狀癲癇持續(xù)狀態(tài)是神經(jīng)內(nèi)科的急重癥，多數(shù)國(guó)家癲癇持續(xù)狀態(tài)均需進(jìn)入NICU進(jìn)行處理，經(jīng)過(guò)適當(dāng)?shù)乃幬镏委熀筒∫蛑委煟?0%病例均可獲得滿意的療效。生命體征穩(wěn)定，神經(jīng)元得到保護(hù)，腦電圖癇樣放電停止，并發(fā)癥得到良好控制。但仍有9-22%的病例癲癇發(fā)作和并發(fā)癥難以控制，并成為難治性癲癇持續(xù)狀態(tài)(refractorystatusepilepticus，RSE)。診斷二種以上藥物治療維持一小時(shí)以上，未能有效控制。*Jan
2、Novy,yGiancarloLogroscino,Refractorystatusepilepticus:Aprospectiveobservationalstudy。Epilepsia,2010，51(2):251–256Statusepilepticus(SE)thatisresistanttotwoantiepilepticcompoundsisdefinedasrefractorystatusepilepticus(RSE).Inthefewavailableretrospectives
3、tudies,estimatedRSEfrequencyisbetween31%and43%ofpatientspresentinganSEepisode;almostallseemtorequireacomainductionfortreatment.WeprospectivelyassessedRSEfrequency,clinicalpredictors,andoutcomeinatertiaryclinicalsetting.*JanNovy,yGiancarloLogroscino,Re
4、fractorystatusepilepticus:Aprospectiveobservationalstudy。Epilepsia,2010，51(2):251–256Twenty-nineof128SEepisodes(22.6%)wererefractorytofirst-andsecond-lineantiepileptictreatments.Severityofconsciousnessimpairmentanddenovoepisodeswereindependentpredicto
5、rsofRSE.RSEshowedaworseoutcomethannon-RSE(39%vs.11%formortality;21%vs.63%forreturntobaselineclinicalconditions).Only12patientswithRSE(41%)requiredcomainductionfortreatment.非驚厥性癲癇持續(xù)狀態(tài)（NCSE）長(zhǎng)程視頻腦電可明顯提高診斷率和監(jiān)測(cè)治療效果EricJ.Ericson,ElizabethE.Gerard，Aphasicsta
6、tusepilepticus:Electroclinicalcorrelation，Epilepsia,52(8):1452–1458,2011Allninepatientswereright-handedwithsubacuteorchroniclefthemisphericlesionsonmagneticresonanceimaging(MRI).Allpatientshadmixedaphasia,threepresentingwithpersistentaphasiafromonseta
7、ndsixwithepisodicspeechimpairment,whichbecamepersistentinfiveofthesix.Theinitial30-minEEGdemonstratedelectrographicseizureinonlyfivepatients(56%),despitethepresenceofaphasiaduringtherecording.Lefthemisphericperiodiclateralizedepileptiformdischarges(PL
8、EDS)wereseenintwopatients,andlefthemisphericslowingintwopatients.EricJ.Ericson,ElizabethE.Gerard，Aphasicstatusepilepticus:Electroclinicalcorrelation，Epilepsia,52(8):1452–1458,2011·Continuousvideo-EEGmonitoringconfirmedelectrographicseizureacti
