全身强直-阵挛型癫痫持续状态56例临床分析

目的探讨全身强直-阵挛型癫痫持续状态的病因、诱发因素、治疗和愈后。方法回顾性分析56例全身强直-阵挛型癫痫持续状态的临床资料。结果全身强直-阵挛型癫痫持续状态病因多样，大部分有明显的诱发因素，临床治疗好转率为87．5％、死亡率为12．5％，16％遗留永久神经损害。结论全身强直-阵挛型癫痫持续状态应积极有效的抢救治疗。     

癫痫持续状态患者血清神经元特异性烯醇化酶的变化

目的 研究癫痫强直一阵挛持续状态和复杂部分持续状态患者血清神经元特异性烯醇化酶(NSE)水平变化。方法 运用酶联免疫双抗法测定癫痫持续状态患者(包括强直一阵挛持续状态14例和复杂部分发作持续状态10例)发作后不同时段血清中NSE水平，并与健康对照组及癫痫对照组比较。结果 发作后2d两组癫痫持续状态患者血清NSE水平均升高，发作后3dNSE水平开始降低，发作后7d强直一阵挛组NSE恢复正常，而复杂部分发作组NSE水平仍高于对照组。结论 癫痫持续状态，尤其是复杂部分发作持续状态可造成脑神经元损伤，需紧急处理。     

癫痫持续状态43例临床观察

癫痫是神经科常见慢性发作性疾病，癫痫持续状态是神经科及急诊科常见急症，持续状态中尤以强直阵挛发作最为危重，须立即进行处理。现对43例癫痫持续状态患者进行临床观察分析，报告如下。     

利多卡因在难治性癫痫持续状态中的应用

目的 认识利多卡因在难治性癫痫持续状态中的作用。方法 对10例难治性强直阵挛发作癫痫持续状态患者持续静脉注射利多卡因，观察其疗效及副作用。结果 9例患者在给药24小时内终止发作，1例在36小时内终止发作。1例出现房性早搏，1例出现窦性心律不齐。结论 利多卡因静脉注射能有效控制难治性癫痫持续状态。     

惊厥性癫痫持续状态并发急性胰腺炎二例分析

目的探讨惊厥性癫痫持续状态（GCSE）并发急性胰腺炎的临床特点和治疗方法。方法 资料完整的GCSE住院患者二例，强直阵挛发作病史11、13年。急性胰腺炎诊断根据血尿淀粉酶化验和腹部超声波、CT检查。结果二例GCSE患者强直阵挛发作持续状态24h后出现继发性急性胰腺炎，经静脉应用地西泮癫痫状态停止，保守和支持治疗胰腺炎痊愈后出院。随访3个月未出现GCSE和腹痛。结论GCSE可以引起急性胰腺炎．GCSE后腹痛应进行急性胰腺炎有关指标的检查，明确诊断后避免使用具有胰腺毒性的抗癫痫药物。     

癫痫持续状态致多系统损害的临床特点

目的分析癫痫持续状态导致多系统损害的临床特征.方法收集1980年11月～2003年4月住院的42例癫痫持续状态多系统损害的患者,其中特发性癫痫1例,症状性癫痫41例,全身强直-阵挛发作41例(97.6%),全身强直性发作1例.分析患者多系统损害情况.结果42例患者中2个系统损害20例(47.6%),3个系统损害10例(23.8%),4个系统损害8例(19.1%),5个系统损害1例(2.4%),6个系统损害2例(4.8%),7个系统损害1例(2.4%).功能衰竭器官中肺为首发脏器,共6例,占14.3%.死亡3例,病死率为7.1%.结论癫痫持续状态致多系统损害多发生于全身强直-阵挛发作,以2个系统同时受累者居多,脏器衰竭以肺最为常见.     

全身强直-阵挛型癫持续状态56例临床分析

目的探讨全身强直-阵挛型癫持续状态的病因、诱发因素、治疗和愈后。方法回顾性分析56例全身强直-阵挛型癫持续状态的临床资料。结果全身强直-阵挛型癫持续状态病因多样,大部分有明显的诱发因素,临床治疗好转率为87.5%、死亡率为12.5%,16%遗留永久神经损害。结论全身强直-阵挛型癫持续状态应积极有效的抢救治疗。     

全身强直-阵挛型癫癎持续状态56例临床分析

目的探讨全身强直-阵挛型癫癎持续状态的病因、诱发因素、治疗和愈后.方法回顾性分析56例全身强直-阵挛型癫癎持续状态的临床资料.结果全身强直-阵挛型癫癎持续状态病因多样,大部分有明显的诱发因素,临床治疗好转率为87.5%、死亡率为12.5%,16%遗留永久神经损害.结论全身强直-阵挛型癫癎持续状态应积极有效的抢救治疗.     

氟乙酰胺中毒致癫痫6例分析

氟乙酰胺是有机氟类农药 ,对人畜毒性大 ,儿童易误服鼠饵中毒 ,我院诊治 6例氟乙酰胺中毒所致癫痫 ,现报告如下 :1　临床资料1 1　一般资料　本组 6例 ,男 4例 ,女 2例 ,年龄 1812 ～ 8岁 ,平均年龄 4 5岁。 6例均误服灭鼠饵中毒 ,全部患儿无癫痫病史。 6例患儿自服毒物至引发抽搐 ,最短 10分钟 ,最长 1小时 ,多在 30分钟左右发病。1 2　神经系统症状及体征　 5例患儿突然出现跌倒 ,意识不清 ,抽搐 ,其中 3例表现为全身性强直阵挛发作 ,2例为肌阵挛伴强直阵挛发作 ,1例先有恶心、呕吐 ,随后出现肌阵挛抽动。 6例中 1例出现癫痫持续状态 ,5例…     

儿童癫痫持续状态59例临床分析

目的 对近年来我院59例儿童癫痫持续状态（SE）患儿的临床发作类型，病因分类及治疗效果进行回顾性分析。方法 59例SE均属惊厥型；（1）全身性51例（86.4%)。其中强直-阵挛型28例，强直型9例，阵挛型14例；（2）部分性8例（13.6%)。均为简单部分性发作，病因分类；（1）特发性16例（原发性癫痫9例，非典型热厥7例）；（2）症状性34例（颅内感染10例；继发性癫痫10例，中毒性脑病5例，其他脑损伤6例，低血钙和突然停用抗癫痫药3例。（3）发热性9例。59例SE入院即行呼吸道管理，监护生命体征及止惊，脱水治疗。结果 本组59例治疗无效1例死亡。结论 严格执行SE急救常规，加强重症监护，针对性治疗，可有效降低SE的致残和死亡率。     

The ketogenic diet in two paediatric patients with refractory myoclonic status epilepticus

Aim. We describe two patients with refractory myoclonic status epilepticus treated with the ketogenic diet. Methods. Between May 1, 2014 and January 1, 2015, two patients who met the diagnostic criteria for refractory myoclonic status epilepticus, seen at our department, were placed on the ketogenic diet and followed for a minimum of six months. Results. One patient with myoclonic epilepsy of unknown aetiology had a 75–90% seizure reduction, and the other with progressive encephalopathy associated with myoclonic epilepsy had a 50% seizure reduction. Both patients retained good tolerability for the diet. At the last control, one patient had isolated myoclonias and EEG showed occasional generalized spike‐and‐polyspike waves; the patient is now successfully attending kindergarten. The quality of life of the second patient improved significantly. In both cases, the number of antiepileptic drugs was reduced. Conclusion. The ketogenic diet is an effective and well‐tolerated treatment option for patients with refractory myoclonic status epilepticus and should be considered earlier in the course of treatment.     

Two Patients with Juvenile Myoclonic Epilepsy and Nonconvulsive Status Epilepticus

We report 2 girls, aged 10 and 13 years, with juvenile myoclonic epilepsy (JME) who had episodes of nonconvulsive status epilepticus (NCSE). Symptoms included only mild lethargy, slow responses, and trembling of the eyelids. There was no ataxia or myoclonus of the limbs or body, and they were always able to respond. Electroencephalograms during these episodes showed almost continuous generalized polyspike-waves in both patients. Patients with JME can develop NCSE, which may be overlooked because of the subtle clinical symptoms.     

Nonconvulsive Status Epilepticus in Adults: Thirty-Two Consecutive Patients from a General Hospital Population

We studied all adult patients who between 1984 and 1989 were initially diagnosed at our hospital as having nonconvulsive status epilepticus. Thirty-two patients fulfilled the criteria, which included ictal EEG recordings. The annual incidence was 1.5 in 100,000 inhabitants. The median age at onset of status was 51 years. Ten patients had status as their first epileptic manifestation, but most patients had a previous history of epilepsy. Median duration of epilepsy at onset of status was 4 years. Fourteen patients had focal ictal seizure activity on EEG and thus met the criteria for complex partial status. Eighteen patients had generalized seizure activity on EEG, but only 6 of these had a history of absence epilepsy or juvenile myoclonic epilepsy. None had Lennox-Gastaut syndrome. The clinical features of status in the remaining 12 patients were in some respects similar to those of the patients with complex partial status. We hypothesize that the EEG seizure activity in these patients may have been generalized from an initial focus.     

An audit of the predictors of outcome in status epilepticus from a resource‐poor country: a comparison with developed countries

Aim. Status epilepticus is a neurological emergency with significant morbidity and mortality. This study describes the clinical profile, treatment, and predictors of outcome of status epilepticus in a tertiary referral centre in a developing country and aims to highlight the similarities and differences from data available from the western world. Methods. A retrospective analysis of data of patients treated for status epilepticus was conducted from prospectively maintained records, between January 2000 and September 2010. The demographic data, clinical profile and investigations (including neuroimaging and EEG), aetiology, treatment, and outcomes were studied and compared with data available from the western world. Results. The analysis included 108 events in 84 patients. A single episode of status epilepticus was treated in 72 patients (86%) and multiple status epilepticus events, ranging from two to six per patient, were managed in 12 patients (14%). Mean age was 24.1±20.3 years and 63% were males. The types of status epilepticus included convulsive status in 98 (90.7%), non‐convulsive status in seven (6.5%), and myoclonic status in three (2.8%). The majority of events (60%) were remote symptomatic, 16% were acute symptomatic, 16% were of unexplained aetiology, and 8% were progressive symptomatic. In 85 events (79%), status epilepticus could be aborted with first and second‐line drugs. The remaining 23 events (21%) progressed to refractory status epilepticus, among which, 13 (56%) were controlled with continuous intravenous midazolam infusion. Case fatality rate was 11%, neurological sequelae were reported in 22%, and 67% returned to baseline. Acute symptomatic status, older age, altered sensorium at the time of admission, and delayed hospitalisation were predictors of poor outcome. Conclusions. Aetiology was the most important determinant of outcome of status epilepticus, as in reports from the western world, with remote symptomatic aetiology secondary to gliosis being the most common. Treatment delay was frequent and adversely affected the outcome.     

脑炎后癫痫持续状态进展为难治性癫痫持续状态及超级难治性癫痫持续状态的早期预测因素

目的 探讨脑炎后癫痫持续状态(SE)进展为难治性SE(RSE)及超级RSE(SRSE)的早期预测因素.方法 根据疾病进展情况将89例脑炎后SE患者分为非RSE组、RSE组及SRSE组.比较各组临床资料.结果 非RSE组、RSE组及SRSE组年龄、SE严重程度评分量表(STESS)评分、基于流行病学SE病死率评分(EMS...     

EpiNet study of incidence of status epilepticus in Auckland,New Zealand: Methods and preliminary results

The EpiNet project has been commenced to facilitate investigator‐led collaborative research in epilepsy. A new Web‐based data collection tool has been developed within EpiNet to record comprehensive data regarding status epilepticus and has been used for a study of status epilepticus in Auckland, New Zealand. All patients aged >4 weeks who presented to any of the five public hospitals and the major private hospital within Auckland city (population = 1.61 million) with an episode of status epilepticus between April 6, 2015 and April 5, 2016 were identified using multiple overlapping sources of information. For this study, status epilepticus was defined as any seizure exceeding 10 minutes in duration, or repeated seizures lasting >10 minutes without recovery between seizures. Patients who had either convulsive or nonconvulsive status epilepticus were included. Episodes of status epilepticus were classified according to the 2015 International League Against Epilepsy ILAE status epilepticus classification. A total of 477 episodes in 367 patients were considered as definite or probable status epilepticus; 285 episodes (62%) lasted >30 minutes, which is the duration that has previously been used for epidemiological studies of status epilepticus.     

Epileptic prodromes: Are they nonconvulsive status epilepticus?

PurposeThe aim of this study was to assess how frequently prodromes occur in an adult patient group from a tertiary referral epilepsy centre and to investigate the EEG changes during the prodromes.Methods578 consecutive patients were interviewed on subjective phenomena, experiences heralding the seizures, for at least 30 min before the start of the seizure. EEGs were recorded during the prodromes.ResultsTen out of 490 included patients had prodromes (2%). We were able to record EEG during prodromes in 6 patients. Three patients had EEG changes corresponding to nonconvulsive status epilepticus. Three patients had unrevealing EEG recordings during prodromes.ConclusionOur results suggest that at least in a part of the patients, the prodromes are actually ictal phenomena, and should be treated as nonconvulsive status epilepticus.     

Nonconvulsive Status Epilepticus: High Incidence of Complex Partial Status

Nonconvulsive status epilepticus may be subdivided into generalized (absence) status and complex partial status. The latter is regarded as a rarity, whereas the former constitutes the dominant part of the hitherto reported cases. We report 10 consecutive cases of adult patients with nonconvulsive status epilepticus, all documented by ictal electroencephalographic (EEG) recordings. Five had a complex partial status; the origin of the complex partial status appeared to be frontal in four of these patients. Three had recurrent complex partial seizures with incomplete recovery between seizures, and two had more continuous symptoms. One of the latter exhibited neither motor phenomena nor automatisms. The effect of diazepam or clonazepam was immediate in all 10 cases though transient in eight. A lasting control of the status was not achieved in six patients until i.v. phenytoin was added. The difficulties in the differentiation between complex partial status and absence status despite ictal EEG recordings are discussed, illustrated by a case with seizure discharges of a focal onset which rapidly generalized. The study indicates that complex partial status may be more common and the clinical expressions of absence status more variable than hitherto recognized.     

Buccal midazolam or rectal diazepam for treatment of residential adult patients with serial seizures or status epilepticus

Nakken KO, Lossius MI. Buccal midazolam or rectal diazepam for treatment of residential adult patients with serial seizure or status epilepticus.
Acta Neurol Scand: 2011: 124: 99–103.
© 2011 John Wiley & Sons A/S. Objectives – To compare the efficacy and tolerability of buccal midazolam with rectal diazepam as emergency treatment in residential adults with convulsive or non‐convulsive serial seizures or status epilepticus (SE), and ascertain the preference between the two treatment options among the patients and the nursing staff. Materials and methods – The nursing staff of our residential epilepsy centre treated 80 episodes of serial seizures or SE lasting more than 5 min alternating with rectal diazepam or buccal midazolam. The dose of each study drug was tailored individually. The primary outcome measure was defined as cessation of seizure activity within 10 min without seizure relapse within 2 h. Results – Convulsive SE was treated promptly, after a mean of 6.2 min, and terminated faster with buccal midazolam than with rectal diazepam; i.e. after a mean of 2.8 vs 5.0 min, respectively (n = 0.012). The other subcategories of emergency situations were treated after a mean of 25.0 min, and the seizure activity ceased after a mean of 7.4 min in the diazepam group and 7.6 min in the midazolam group (NS). The success rate was 83.3% in the diazepam group and 74.4% in the midazolam group (NS). The difference was mostly due to slightly more seizure relapses during the first 2 h in the midazolam group. Both treatment options were well tolerated, temporary tiredness being the most frequently occurring adverse effect. All the nursing staff and six of the seven patients who gained experience with both treatment options favoured the buccal route. Conclusions – Buccal midazolam appeared to be at least as effective as rectal diazepam with little or no side effects. The buccal administration was easy to handle and socially more acceptable than the rectal route.     

Myoclonic status epilepticus as a presentation of caspr2 antibody‐associated autoimmune encephalitis

We present a case of autoimmune encephalitis associated with antibodies targeting contactin‐associated protein‐like 2. This case is notable because of the presentation with myoclonic status epilepticus and the prolonged clinical course of refractory seizures, which are demonstrated in the accompanying videos, and not previously associated with this condition. Treatment with prednisone, intravenous immunoglobulin, plasma exchange, rituximab, cyclophosphamide, and mycophenolate mofetil resulted in significant functional improvement. Historically, myoclonic status epilepticus is associated with a grave prognosis and minimal chance of meaningful recovery. This case demonstrates that autoimmune encephalitis remains an important differential diagnosis in patients with such a presentation, and that early recognition and the appropriate institution of immunotherapy can result in seizure control and functional recovery. [Published with video sequences]