癫痫持续状态患者的临床治疗分析

目的探讨对癫痫持续状态的临床用药方法及疗效。方法回顾性分析2008年1月至2009年12月住院的癫痫持续状态50例患者的临床资料。结果本组50例患者经治疗,完全控制21例,显效15例,有效10例,效差3例,无效1例,有效率为92%;儿童患者治疗效果优于成人患者,两组有效率比较,差异有统计学意义(P<0.05)。结论癫痫持续状态重在寻找病因、控制发作和有针对性的治疗,及时有效地控制痉挛发作是抢救癫痫持续状态的关键。     

咪达唑仑治疗小儿惊厥性癫痫持续状态34例疗效观察

目的探讨咪达唑仑持续静脉滴注对小儿难治性惊厥性癫痫持续状态治疗的有效性和安全性。方法观察我院儿科2008年8月至2009年10月运用咪达唑仑持续静脉滴注治疗小儿难治性惊厥性癫痫持续状态34例的疗效及副作用等指标。结果 34例难治性惊厥性癫痫持续状态予咪达唑仑治疗总有效率为76.5%,其中以原发性癫痫和用药前惊厥持续时间在24h以内疗效较好,无一例与用药有关的副作用发生。结论咪达唑仑持续静脉滴注治疗是对小儿难治性惊厥性癫痫持续状态是一种安全、有效的治疗措施。     

癫痫持续状态患者临床治疗分析

目的：探讨癫痫持续状态的临床用药方法及疗效。方法：回顾性分析本科77例癫痫持续状态患者的临床资料,并对患者的治疗及疗效进行总结。结果：本组77例患者经治疗,完全控制47例,显效18例,有效7例,效差3例,无效1例,有效率为93.5%。结论：癫痫持续状态重在寻找病因、控制发作和有针对性的治疗,及时有效地控制痉挛发作是抢救癫痫持续状态的关键。     

癫痫持续状态的救治体会

癫痫持续状态又称癫痫状态,指一次癫痫发作至少持续30min以上,或者两次发作间歇期意识不恢复者.处理不当或不及时可导致死亡或严重的永久性脑损害.一直以来,地西泮被认为是治疗癫痫持续状态的首选药物,但各家医院使用的方法及剂量差异较大.我科近年来收治了32例癫痫持续状态患者,探索出一套行之有效的用药方法,现报告如下.     

对癫痫持续状态病人的整体护理

癫痫病是一种比较常见的神经系统疾病,以儿童及青年多见。癫痫患者若不进行正规治疗和良好护理,可能频繁出现癫痫发作。甚至导致出现癫痫持续状态,危及生命。因此家庭、社会及医护人员对癫痫病人应加强关心、爱护,使其情绪稳定,以降低发作率。我科从1999-08～2007-12共收治癫痫持续状态病人104例,经过治疗和积极的整体护理后病情明显好转。现报道如下。     

癫痫持续状态患者的护理对策

<正>癫痫持续状态指频繁而持久的癫痫发作所形成的一种固定的癫痫状态,包括癫痫连续多次发作,发作期间意识不清或1次发作持续在30min以上者。任何类型癫痫均可出现癫痫持续状态,通常是指全面强直—阵挛发作持续状态,病残率、致死率均高。发作中体温、呼吸、循环、意识的监护和处理,发作控制后的用药及健康指导,这些贯穿于癫痫持续发作始终的护理工作是尤为重要的。本院神经内科对治癫痫持续状态患者采取综合护理     

1例病毒性脑炎并发癫痫持续状态患者的药学监护实践

摘 要 目的：探讨病毒性脑炎并发癫痫持续状态患者的药学监护内容,协助医生,确保患者用药安全。方法：结合病毒性脑炎并发癫痫持续状态的治疗原则,分析治疗方案,协助医师制定治疗方案,对1例病毒性脑炎并发癫痫持续状态患者制定药学监护计划并实施全程药学监护。结果：临床药师通过实施药学监护,优化了治疗方案,解决了临床问题。结论：对病毒性脑炎并发癫痫持续状态患者实施药学监护,及时发现患者治疗中存在的问题,提高了药物治疗的安全性、有效性。     

醒脑静注射液对癫痫持续状态患者NSE及MMP-9的影响

目的 观察癫痫持续状态患者应用醒脑静注射液治疗后神经元特异性烯醇化酶(NSE)以及血清基质金属蛋白酶-9(MMP-9)水平的动态变化,并通过对比不同患者的预后,探讨醒脑静的治疗意义.方法 随机将74例癫痫持续状态患者分为两组,A组应用地西泮、甘露醇联合醒脑静治疗,B组应用地西泮、甘露醇治疗,分别在用药前以及用药后72小时分别抽血应用ELISA法对患者NSE以及MMP-9水平进行动态检测.选取34例无持续状态发作的癫痫患者作为对照组C组,监测患者血清NSE及MMP-9值作为对照.结果 癫痫持续状态患者血清NSE及MMP-9明显升高(P＜0.05),A组血清NSE及MMP-9在72小时内下降明显快于B组(P＜0.05).结论 癫痫持续状态患者发病后血清NSE及MMP-9迅速升高,醒脑静联合治疗能更好的降低血清NSE及MMP-9,从而说明醒脑静对脑组织起到一定的保护作用.     

拉莫三嗪治疗儿童良性癫痫伴中央颞区棘波合并睡眠中癫痫性电持续状态临床研究

<正>儿童睡眠中癫痫性电持续状态(ESES)是一种年龄依赖性的神经电生理的脑电现象,发生率占儿童癫痫的0.2%~0.5%,多见于3~14岁儿童,脑电图特点为睡眠中非快眼动睡眠(NREM)期阵发性广泛或局限性棘慢波发放,清醒期电持续状态消失,是一种发作间期脑电图形[1],其可出现于多种癫痫综合征中,目前尚无同一的治疗方法。本研究所选取的23     

癫痫持续状态的诊疗进展

<正> 癫痫持续状态是神经内科常见的急症之一,作为一个神经内科医生应掌握癫痫持续状态的处理原则。大多数癫痫持续状态的发作不超过2～3min。发作超过5min就有很高的机会进展到癫痫状态,因此早期治疗至关重要。1 癫痫持续状态的定义及发展历史 1903年Clark and Prout首先提出癫痫持续状态的定义:癫痫持续状态是指癫痫的严重程度,一次发作后短时间内另一次发作,两次发作间持续昏迷     

Refractory generalised convulsive status epilepticus : a guide to treatment

The patient with status epilepticus has continuous or rapidly repeating seizures. Generalised convulsive status epilepticus (GCSE) is the most common form of the disorder and is a life-threatening condition that requires prompt medical management. Status epilepticus that does not respond to first-line benzodiazepines (lorazepam or diazepam) or to second-line antiepileptic drugs (phenytoin/fosphenytoin, phenobarbital or valproate) is usually considered refractory and requires more aggressive treatment.The optimal treatment of refractory GCSE has not been defined, but patients should be treated in an intensive care unit, as artificial ventilation and haemodynamic support are required. Invasive haemodynamic monitoring is often necessary and EEG monitoring is essential.The drug treatment of refractory GCSE involves general anaesthesia with continuous intravenous anaesthetics given in doses that abolish all clinical and electrographic epileptic activity, often requiring sedation to the point of burst suppression on the EEG. Barbiturate anaesthetics, pentobarbital in the US and thiopental sodium in Europe and Australia, are the most frequently used agents and are highly effective for refractory GCSE both in children and adults. Indeed, they remain the only way to stop seizure activity with certainty in severely refractory cases. Other options are midazolam for adults and children and propofol for adults only.Regardless of the drug selected, intravenous fluids and vasopressors are usually required to treat hypotension. Once seizures have been controlled for 12-24 hours, continuous intravenous therapy should be gradually tapered off if the drug being administered is midazolam or propofol. Gradual tapering is probably not necessary with pentobarbital or thiopental sodium. Continuous EEG monitoring is required during high-dose treatment and while therapy is gradually withdrawn. During withdrawal of anaesthetic therapy, intravenous phenytoin/fosphenytoin or valproate should be continued (these agents having been administered during earlier phases of GCSE) to ensure an adequate baseline of antiepileptic medication so as to prevent the recurrence of status epilepticus. If additional medication is needed, the most appropriate antiepileptic drugs are gabapentin for focal seizures and levetiracetam and topiramate for all seizure types, as these drugs can be started at high doses with a low risk of idiosyncratic reactions.Even with current best practice, mortality in patients who experience refractory GCSE is about 50% and only the minority return to their premorbid functional baseline. Therefore, new treatment options are urgently needed. The ideal new drug for refractory GCSE would be one that has the ability to stop seizures more effectively and safely than current drugs, and that has neuroprotective properties to prevent the brain damage and neurological morbidity caused by GCSE.     

咪达唑仑在小儿癫痫持续状态中的应用效果

摘 要：目的：探讨小儿癫痫持续状态治疗中应用咪达唑仑的效果。方法：2012年1月至2015年3月间在我院接受治疗的癫痫持续状态患儿68例,采用随机数字表法分为对照组（34例,给予地西泮）和观察组（34例,给予咪达唑仑治疗）,比较两组临床效果、癫痫持续状态控制情况、患儿血压、心率变化及不良反应发生情况。结果：观察组患儿治疗总有效率为94.44%（32/34）,高于对照组70.59%（24/34）;观察组药物起效时间及癫痫状态控制时间均短于对照组,患儿心率、平均动脉压变化情况优于对照组,不良反应发生率低于对照组,差异明显,均有统计学意义（P＜0.05）。结论：小儿癫痫持续状态治疗中应用咪达唑仑效果可靠,药物起效快,可有效控制患儿癫痫状态,且对患儿心率、血压影响小,不良反应少,临床应用价值显著。     

Utility of antiepileptic drug monitoring in the pediatric emergency department

Convulsive disorders are common in the pediatric age group, and measurement of serum concentration of an antiepileptic drug (AED) is frequently ordered for epileptic patients in the emergency department (ED). The objective of this study was to develop a better understanding of the indications for, and consequences of, monitoring AED serum concentrations in the pediatric ED. Charts of 116 patients who visited the ED and were tested for blood levels of AED were retrospectively reviewed. Main outcome measures were number and percentage of levels outside the therapeutic range, discontinuation of an AED or introduction of a new one, dosage modifications, and admission to hospital. Two pediatricians and a pediatric neurologist aware only of patients' age, weight, diagnosis, history, clinical presentation, and drug details reviewed each case and on the basis of predetermined criteria decided whether measurement of AED was indicated. Mean age (+/- SD) of the study population was 7 +/- 5 years (range, 2 months-17 years). Forty-two patients (36%) were on monotherapy, and 74 (64%) were on polytherapy. Sixty-eight patients (59%) presented with increased seizure frequency, 7 (6%) with status epilepticus, and 13 (11%) with suspected AED toxicity. The remainder of the children presented with problems unrelated to epilepsy. No significant difference was found between patients with AED levels within the therapeutic range and those with levels outside it in the proportion of children needing dosage change, change in medication, or hospital admission (P = 0.5, 0.8, and 0.8, respectively). None of the patients presenting with status epilepticus and only 15% of those with increased seizure activity had subtherapeutic levels. Review of the cases suggested that measuring serum AED level was not indicated in 57 (49.1%) patients. In the pediatric ED, abnormal AED levels do not correlate with clinical management. Before ordering tests, physicians should consider whether their results would alter patient treatment.     

癫痫持续状态患者的病因分析

目的 回顾性研究58例癫痫持续状态患者的病因,提早预防,减少此病的发病率及并发症.方法 选取2001-2012年德阳市人民医院神经内科的58例癫痫持续状态的患者进行回顾性分析,分析病因及治疗结果.结果 癫痫持续状态的病因有原发性癫痫、颅内感染、脑血管病、脑肿瘤、代谢性脑病、自行停用抗癫痫药以及酗酒.经抢救后,51例患者癫痫发作得到控制,7例患者死亡,病死率为12.07%.结论 颅内感染、脑血管病、脑肿瘤、代谢性脑病、自行停用抗癫痫药和酗酒为严重癫痫发作的常见病因,有较大的早期预防、提前干预的价值,一旦发生癫痫持续状态,病情将极其危重,救治困难.     

儿童睡眠癫痫电持续状态的临床与脑电图变化

目的探讨儿童睡眠癫痫电持续状态(ESES)临床和脑电图变化。方法收集2009年6月至2011年8月本院诊断ESES的患儿31例,分析其临床资料。结果 21例患儿单药控制临床发作疗效欠佳,丙戊酸钠联合用药治疗反应良好,首发年龄越小,则发作和EEG异常的持续时间越长。药物及激素治疗效果越差。13例(42%)予甲泼龙冲击治疗,9例(69%)在甲泼尼龙冲击疗程结束后癫痫发作控制,或发作减少50%以上,3例(23%)发作无改善。5例(38%)神经心理损伤及运动倒退情况明显好转,2例(15%)好转半年后再次出现神经心理倒退,6例(46%)较治疗前无变化。结论甲泼尼龙对ESES临床治疗疗效不一。对于消除中央区-颞区电持续续状态效果明显,但对特发性枕区癫痫伴ESES现象及年龄<2岁癫痫患儿疗效欠佳。     

Treatment options for status epilepticus

Status epilepticus is a neurological emergency requiring prompt pharmacological intervention. Recent advances in the treatment of this condition include the introduction of treatment algorithms that are tailored more specifically to clinical situations, a trend towards more aggressive therapies if initial treatment with front-line agents fail, and a better understanding of the role of treatment for patients in status epilepticus in the out-of-hospital setting.     

Treatment options for status epilepticus

Status epilepticus is a neurological emergency requiring prompt pharmacological intervention. Recent advances in the treatment of this condition include the introduction of treatment algorithms that are tailored more specifically to clinical situations, a trend towards more aggressive therapies if initial treatment with front-line agents fail, and a better understanding of the role of treatment for patients in status epilepticus in the out-of-hospital setting.     

Stiripentol for the treatment of seizures in Dravet syndrome

Introduction: Dravet syndrome is an early childhood-onset epilepsy syndrome characterized by drug-resistant seizures, frequent episodes of status epilepticus, and the development of neurocognitive impairment. Seizure freedom in this condition is rare and there is a higher rate of sudden unexplained death in epilepsy patients (SUDEP) than other epilepsy syndromes. Stiripentol is a recently approved medication with an indication specifically for the treatment of seizures in children with Dravet syndrome.

Areas covered: Review of relevant literature including the current and emerging treatment of seizures in children with Dravet syndrome, with a focus on stiripentol. This includes a review of the literature regarding the mechanism of action, clinical efficacy, and safety/tolerability of stiripentol.

Expert opinion: Stiripentol has been available through expanded access programs resulting in a reduction of seizures and episodes of status epilepticus. With the Federal Drug Administration (FDA) approval, this treatment option will be more readily available to the Dravet syndrome population in the United States. The approval comes at a time of other treatment options also receiving approval (cannabidiol) and several products in ongoing studies (fenfluramine, TAK-935) providing additional treatment options and hope on the horizon for those impacted by this severe epilepsy syndrome.     

Endocannabinoids block status epilepticus in cultured hippocampal neurons

Status epilepticus is a serious neurological disorder associated with a significant morbidity and mortality. Antiepileptic drugs such as diazepam, phenobarbital and phenytoin are the mainstay of status epilepticus treatment. However, over 20% of status epilepticus cases are refractory to the initial treatment with two or more antiepileptic drugs. Endocannabinoids have been implicated as playing an important role in regulating seizure activity and seizure termination. This study evaluated the effects of the major endocannabinoids methanandamide and 2-arachidonylglycerol (2-AG) on status epilepticus in the low-Mg(2+) hippocampal neuronal culture model. Status epilepticus in this model was resistant to treatment with phenobarbital and phenytoin. Methanandamide and 2-AG inhibited status epilepticus in a dose-dependent manner with an EC(50) of 145+/-4.15 nM and 1.68+/-0.19 microM, respectively. In addition, the anti-status epilepticus effects of methanandamide and 2-AG were mediated by activation of the cannabinoid CB(1) receptor since they were blocked by the cannabinoid CB(1) receptor antagonist AM251. These results provide the first evidence that the endocannabinoids, methanandamide and 2-AG, are effective inhibitors of refractory status epilepticus in the hippocampal neuronal culture model and indicate that regulating the endocannabinoid system may provide a novel therapeutic approach for treating refractory status epilepticus.     

癫痫持续状态的临床研究

目的:探讨癫痫持续状态的病因、临床特点、诊断和治疗方法.方法:对51例癫痫持续状态患者的临床资料进行回顾性分析.结果:经积极治疗后48例患者得到有效控制,3例自动出院后死亡,病死率为5.9%.结论:脑血管病是癫痫持续状态最常见的病因,在有癞痫史的患者中停药或换药是最常见的诱因.尽早诊断,及时治疗可以提高抢救成功率.坚持服药,减少各种不良诱因是预防本病的关键.