硫喷妥钠治疗癫痫持续状态的疗效观察

目的 探讨对癫痫持续状态的有效治疗。方法 对67例全面性强直-阵挛发作型癫痫持续状态分别采用安定和硫喷妥钠进行治疗并观察疗效。结果 安定和硫喷妥钠在30min内对癫痫持续状态的控制率分别为69．56％和100％。结论 硫喷妥钠可以作为控制癫痫持续状态的首选治疗药物。     

癫痫产生及发展过程中γ-氨基丁酸A受体突触后的改变

近年来对惊厥活动中γ-氨基丁酸A受体的细胞、药理、遗传学方面的研究显示抑制性γ-氨基丁酸A受体的结构和功能的改变与癫痫发生和癫痫持续状态密切相关。尤其是γ-氨基丁酸A受体亚单位的基因突变与原发性全面性癫痫发作有着密切的联系。     

癫痫产生及发展过程中γ-氨基丁酸A受体突触后的改变

近年来对惊厥活动中γ-氨基丁酸A受体的细胞、药理、遗传学方面的研究显示抑制性γ-氨基丁酸A受体的结构和功能的改变与癫痫发生和癫痫持续状态密切相关。尤其是γ-氨基丁酸A受体亚单位的基因突变与原发性全面性癫痫发作有着密切的联系。     

小儿癫痫持续状态15例临床分析

目的 探讨小儿癫痫持续状态的病因、临床表现与治疗结局。方法 回顾性分析15例癫痫持续状态患儿的临床资料。结果 病因为癫痫者8例,病毒性脑炎4例,肾上腺皮质功能减退1例,脑瘫2例;12例为全面性发作,3例为局灶性发作;6例行常规脑电图检查,异常4例,正常2例,视频脑电图发现癫痫样放电4例;行头颅MRI检查8例,异常4例;13例经静脉注射安定、联合苯巴比妥肌内注射或水合氯醛灌肠后发作控制,1例给予丙戊酸钠静脉滴注后发作控制,1例加用氯硝基安定后抽搐停止。结论 癫痫持续状态病因、临床表现形式不同,早期识别、快速有效控制发作是治疗关键。     

难治性癫痫持续状态研究进展

难治性癫痫持续状态是指应用2种抗癫痫药物联合治疗仍无效的癫痫持续状态,约30%的癫痫持续状态患者可转为难治性癫痫,病死率较高。本文就难治性癫痫持续状态定义、病因、临床表现、并发症、治疗及预后的研究进展作一综述。     

癫痫持续状态的临床研究

目的观察癫痫持续状态的临床特点及治疗。方法采用病例的回顾，对49例癫痫持续状态的临床资料进行分析。结果引起癫痫持续状态的病因以脑血管病常见；突然停药或不规则服用抗癫痫药物是癫痫持续状态的常见诱因；采用安定和苯巴比妥钠联合应用对控制癫痫持续状态有较好的临床疗效；及时有效的控制癫痫持续状态是挽救生命改善其预后的关键。结论癫痫持续状态的正确诊断，及时处理，抢救成功率高。     

癫痫持续状态及治疗

癫痫持续状态又称癫痫状态(Status edileptius).一般指频繁或持续的癫痫发作所导致的固定而持久的癫痫状态,或一次癫痫发作至少持续30分钟以上,或两次发作间歇期意识不恢复者.癫痫持续状态的发生率占癫痫患者的2.6%～6%.癫痫持续状态不是癫痫的一型,各型癫痫都可以出现持续状态.小儿持续状态的发生率较其他各年龄组高,是神经科常见危急重症.如能及时诊断处理,可降低病死率.     

老年癫痫的发病原因和临床特征的研究

目的探讨老年癫痫病患者的常见发病原因、临床特点、预后情况。方法回顾性分析56例老年癫痫患者临床资料、发病原因、发病特点等。结果 56例病例中,由于突发性癫痫发作而入院13例(23.2%),在住院时出现癫痫发作43例(76.8%),住院时癫痫发作的患者明显多于突发性癫痫发作而入院的患者(χ2=32.142,P=0.000)。而其中部分性发作的患者7例(12.5%),全面性发作的患者40例(71.4%),癫痫持续状态9例(16.1%),全面性癫痫发作患者明显多于其他发作类型的患者(χ2=20.571,P=0.000)。老年癫痫发作的原因中脑梗死患者明显多于其他病因的患者数(χ2=14.286,P=0.000)。在34例死亡病例中,在癫痫发作后1个月内死亡7例(20.6%),2~6个月死亡9例(26.5%),7~12个月死亡7例(20.6%),1~3年死亡11例(32.3%)。结论老年癫痫患者中的主要发病原因是脑血管病,主要的发作形式是全面性发作。老年癫痫群体中的常规脑电图检查率低,且癫痫放电率低。     

癫痫持续状态60例治疗体会

癫痫持续状态为在短期内频繁发生,以致发作间隙中意识持续昏迷者,称癫痫持续状态.常伴高热、脱水、白细胞增多和酸中毒.癫痫持续状态是急诊中常见的危重症,如诊断处理及时,可降低病死率.现将我们经治的癫痫持续状态60例体会报告如下.     

1例癫痫持续状态致昏迷患者的抢救护理体会

正癫痫持续状态(Status Epilepticus,SE)或称癫痫状态,是癫痫连续发作之间意识未完全恢复又频繁再发,或癫痫发作持续30 min以上未自行停止~[1]。癫痫持续状态是神经内科常见的急症,不及时治疗可因循环衰竭、电解质紊乱或神经元兴奋、毒性损伤导致永久性脑损害,致残率和死亡率均很高。任何类型的癫痫均可出现持续状态,其中全面强直-阵挛发作最常见,危害性也最大~[2]。本科于2015年10月24日收治1例癫痫持续状态致昏迷的患者,经精心救     

Nonconvulsive status epilepticus

Nonconvulsive status epilepticus (NCSE) refers to a prolonged seizure that manifests primarily as altered mental status as opposed to the dramatic convulsions seen in generalized tonic-clonic status epilepticus. There are 2 main types of NCSE, each of which has a different presentation, cause, and expected outcome. In the first type of NCSE, patients present with confusion or abnormal behavior, suggesting the diagnosis of absence status epilepticus (ASE) or complex partial status epilepticus (CPSE). The second type of NCSE (subtle status epilepticus [SSE]) must be considered in comatose patients who present after a prolonged generalized tonic-clonic seizure and who may have only subtle motor manifestations of a seizure, such as facial or hand twitchings. Whereas the morbidity and mortality in patients with prolonged ASE or CPSE is low, the mortality associated with SSE can exceed 30% if the seizure duration is greater than 60 minutes.     

Management of status epilepticus

Status epilepticus is an increasingly recognized public health problem in the United States. Status epilepticus is associated with a high mortality rate that is largely contingent on the duration of the condition before initial treatment, the etiology of the condition, and the age of the patient. Treatment is evolving as new medications become available. Three new preparations--fosphenytoin, rectal diazepam, and parenteral valproate--have implications for the management of status epilepticus. However, randomized controlled trials show that benzodiazepines (in particular, diazepam and lorazepam) should be the initial drug therapy in patients with status epilepticus. Despite the paucity of clinical trials comparing medication regimens for acute seizures, there is broad consensus that immediate diagnosis and treatment are necessary to reduce the morbidity and mortality of this condition. Moreover, investigators have reported that status epilepticus often is not considered in patients with altered consciousness in the intensive care setting. In patients with persistent alteration of consciousness for which there is no clear etiology, physicians should be more quickly prepared to obtain electroencephalography to identify status epilepticus. Physicians should rely on a standardized protocol for management of status epilepticus to improve care for this neurologic emergency.     

Treatment of acute seizures and status epilepticus

Overt status epilepticus and persistent obtundation after a witnessed clinical seizure are neurologic emergencies. Early recognition and intervention in the electroclinical syndrome of status epilepticus reduces morbidity, although treatment of the underlying etiology is also critical. This review outlines key concepts related to status epilepticus, delineates an approach to the early management of status epilepticus, and highlights novel but practical approaches in the evaluation and treatment of refractory status epilepticus, emphasizing the use of a treatment algorithm. This review is written from the perspective of the intensive care unit clinician, and the approach and opinions expressed stem from clinical experience and review of the current literature. Particular attention is given to an overall approach to the management of convulsive status epilepticus in adults and older children as well as exploring novel approaches and diagnostic tools that may prove useful in difficult-to-control status epilepticus.     

Refractory status epilepticus

PURPOSE OF REVIEW: Although conventional anticonvulsant agents can terminate status epilepticus in most cases, a substantial minority of patients develops medically refractory status and requires more aggressive care. This review explores the options available. RECENT FINDINGS: Increasing numbers of previously unexpected etiologies for refractory status epilepticus continue to be reported. There are also some promising new therapies on the horizon, both for the short and the longer terms. SUMMARY: Refractory status epilepticus, while a challenge to the intensivist, can be treated with drugs that are commonly used by intensivists. The cooperation of an interested electroencephalographer is vital.     

New management strategies in the treatment of status epilepticus

Status epilepticus is a neurologic emergency associated with high mortality and long-term disability. Recent advances in our understanding of the pathophysiological mechanisms involved in the initiation and perpetuation of seizure activity have revealed that status epilepticus is a dynamic and evolving process. Alterations at the cellular level parallel physiological, physical, and electrical changes at the bedside. Loss of cerebral autoregulation and neuronal damage begin after 30 minutes of continuous seizure activity. This understanding has led to changes in treatments of status epilepticus, which must be multidisciplinary and occur simultaneously in many different areas. The goals of pharmacological therapy are to terminate seizures early and prevent recurrence. Two recent large clinical studies have shown the benefit of early administration of benzodiazepines to control status epilepticus. Pharmacological algorithms designed to focus medical management have trended toward earlier and more aggressive treatment. The hope is that continued exploration into the basic mechanisms involved in status epilepticus and future controlled clinical trials defining optimal medical management will produce further advances.     

Non-convulsive status epilepticus in a patient with hypocalcemia

Non-convulsive status epilepticus (NCSE), a neurological emergency, is reported to account for approximately 25% of patients presenting in status epilepticus. Diagnosis of NCSE can be delayed or missed because of its often subtle presentation. Hypocalcemia has rarely been reported as a precipitator of NCSE and thus should be considered in the differential. We report the case of a 46-year-old man with idiopathic hypoparathyroidism who presented in NCSE secondary to hypocalcemia. As in patients with convulsive status epilepticus, rapid diagnosis and treatment of patients in NCSE is critical to prevent permanent neurological damage.     

万可松联合呼吸机辅助呼吸治疗顽固性癫痫持续状态

目的 探讨万可松联合呼吸机辅助呼吸治疗6例顽固性癫痫持续状态患者的疗效。方法 对于采用常规抗癫痫治疗12h后无效的顽固性癫痫持续状态的6例患者,均应用静脉注射万可松联合气管切开、呼吸机辅助呼吸治疗7～15d以控制癫痫发作。结果 6例患者癫痫发作症状得到明显控制,药物起效时间3～6h,停药后平均自动转复时间为30～60min;疗程中未出现与治疗相关的呼吸、循环功能障碍,患者均安全出院。结论 万可松联合呼吸机辅助呼吸治疗顽固性癫痫持续状态是安全、有效、可行的。     

Nonconvulsive status epilepticus in a patient with leptomeningeal cancer

A 56-year-old man sought medical assistance because of recurrent nonconvulsive status epilepticus without a history of prior seizure activity. Examination of the cerebrospinal fluid disclosed leptomeningeal cancer. To our knowledge, the association of partial complex status epilepticus and leptomeningeal cancer has not been reported previously. If the results of computed tomographic and magnetic resonance imaging studies are normal, examination of cerebrospinal fluid should be considered in patients with nonconvulsive status epilepticus.     

Hanging-induced status epilepticus

Survival from hanging is associated with a variety of neuropsychiatric consequences, including amnesia, localized muscle spasms, transient hemiplegia, central cord syndrome, and multiple transient neurologic findings. This report describes a near-hanging episode in a patient who subsequently had status epilepticus requiring 40 mg of diazepam and 1,200 mg of phenytoin for control in the prehospital and emergency department stabilization period. This is the first well-documented report of hanging with subsequent status epilepticus in an adult. The patient survived with an abnormal electroencephalogram consistent with anoxic injury and was discharged on anticonvulsant therapy, although the rationale for medication in such patients is unclear and requires further study.     

早期机械通气联用硫喷妥钠控制老年癫痫持续状态初探

目的评价早期机械通气联用硫喷妥钠抢救老年患者癫痫持续状态的疗效。方法45例老年患者依据临床特征、脑电图确诊为癫痫持续状态,入院后立即行硫喷妥钠1.0g加入0.9%氯化钠溶液中,使用微量泵3~8mg/min静滴。同时采用气管插管机械通气,根据血气分析合理选择呼吸模式和调节呼吸机参数,加强呼吸道管理。结果45例于5~30min内抽搐全部控制,3~24h内意识转清,生命体征、血气分析均恢复正常。结论早期机械通气联用硫喷妥钠控制老年患者癫痫持续状态快速、高效、安全。