非抽搐性癫痫持续状态五例及文献复习

Non-convulsive status epilepticus： 5 cases report and literature review

目的 探讨非抽搐性癫痫持续状态（NCSE）患者的临床表现及持续脑电监测的脑电图（EEG）特征.方法 对自2008年11月至2009年12月北京大学人民医院急诊科收治的5例NCSE患者行持续EEG监测检查,观察其EEG特征及临床表现.结果 5例均出现发作性意识障碍,其中4例出现烦躁、易怒或躁狂,3例表现出精神运动迟滞和遗忘,2例出现言语自动症和失认,1例出现定向障碍.所有患者的EEG均出现广泛性但一侧明显的异常放电.静脉注射地两泮后,3例患者临床症状迅速改善.结论 NCSE并非罕见,持续EEG监测能查出本病,早期诊断,及时治疗可改善患者预后,临床应注意与其他引起意识紊乱的疾病相鉴别.

Objective To describe the clinical and electroencephalographic features as well as the possible etiology and treatment of patients with non-convulsive status epilepticus （NCSE）. Methods We identified 5 adult patients with NCSE from the epilepsy database of the comprehensive epilepsy. Continuous electroencephalographic （EEG） monitoring was analyzed and chart review was performed to analyze their clinical and electroencephalographic features. Results The patients ranged from 19 to 66 years old. All of the 5 patients showed impaired consciousness： 4 demonstrated agitation and paranoia; 3 had both psychomotor retardation and amnesia; 2 developed verbal automatisms and agnosia; and I had disorientation. All the patients had associated generalized discharges but lateralized dominant. Three patients showed clinical improvement following administration ofbenzodiazepines. Conclusion The NCSE is not a rare case and continuous EEG monitoring can help the diagnosis. Prompt recognition and treatment may be necessary in improving the neurological outcome, and attention should be paid to the identification with other diseases that cause impairment of conscience.