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1、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2012-11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(refractorystatusepilepticus，RSE)。诊断二种以上药物治疗维持一小时以上，未能有效控制。*JanNovy,yGiancarloLogroscino,Refr
2、actorystatusepilepticus:Aprospectiveobservationalstudy。Epilepsia,2010，51(2):251–256Statusepilepticus(SE)thatisresistanttotwoantiepilepticcompoundsisdefinedasrefractorystatusepilepticus(RSE).Inthefewavailableretrospectivestudies,estimatedRSEfrequencyisbetween31%and43%ofpatientspres
3、entinganSEepisode;almostallseemtorequireacomainductionfortreatment.WeprospectivelyassessedRSEfrequency,clinicalpredictors,andoutcomeinatertiaryclinicalsetting.*JanNovy,yGiancarloLogroscino,Refractorystatusepilepticus:Aprospectiveobservationalstudy。Epilepsia,2010，51(2):251–256Twent
4、y-nineof128SEepisodes(22.6%)wererefractorytofirst-andsecond-lineantiepileptictreatments.SeverityofconsciousnessimpairmentanddenovoepisodeswereindependentpredictorsofRSE.RSEshowedaworseoutcomethannon-RSE(39%vs.11%formortality;21%vs.63%forreturntobaselineclinicalconditions).Only12pa
5、tientswithRSE(41%)requiredcomainductionfortreatment.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EricJ.Ericson,ElizabethE.Gerard，Aphasicstatusepilepticus:Electroclinicalcorrelation，Epilepsia,52(8):1452–1458,2011Allninepatientswereright-handedwithsubacuteorchroniclefthemisphericlesionsonma
6、gneticresonanceimaging(MRI).Allpatientshadmixedaphasia,threepresentingwithpersistentaphasiafromonsetandsixwithepisodicspeechimpairment,whichbecamepersistentinfiveofthesix.Theinitial30-minEEGdemonstratedelectrographicseizureinonlyfivepatients(56%),despitethepresenceofaphasiaduringt
7、herecording.Lefthemisphericperiodiclateralizedepileptiformdischarges(PLEDS)wereseenintwopatients,andlefthemisphericslowingintwopatients.EricJ.Ericson,ElizabethE.Gerard，Aphasicstatusepilepticus:Electroclinicalcorrelation，Epilepsia,52(8):1452–1458,2011·Continuousvideo-EEGmonitoringc
8、onfirmedelectrographicseizureacti
