儿童非惊厥性癫痫持续状态的诊断与治疗

Diagnosis and treatment of nonconvulsive status epilepticus in children

美国神经重症监护学会定义癫痫持续状态为5min以上，临床和／或脑电发作持续，或反复发作未恢复到基线状态。非惊厥性癫痫持续状态（NCSE）分为伴和不伴昏迷／木僵的NCSE2大类。诊断NCSE需要持续视频脑电图监测，监测指征包括：（1）惊厥后或急性脑损伤后，或因其他不明原因的精神状态改变；（2）癫痫发作治疗效果评估，明确非惊厥发作或NCSE是否已控制，需持续监测视频脑电24～48h；（3）脑缺血的识别。修订的Salzburg NCSE共识性标准认为诊断NCSE需结合脑电图和临床资料。临床症状／体征怀疑NCSE的，至少持续10min，脑电图改变至少持续10s。治疗首选苯二氮革类，必要时加抗癫痫药物治疗，60min以上发作仍未控制的选用麻醉药或其他治疗。

The Neurocritical Care Society＇s Guidelines for the Evaluation and Management of Status Epilepticus defines status epilepticus as the epilepsy lasts for 5 minutes or longer,with continuous clinical and/or electrographic seizure activity or recurrent seizure activity without recovery （returning to baseline） between seizures. Nonconvulsive status epilepticus （NCSE） can be classified into with or without coma/stupor types. The diagnosis of NCSE needs continuous video electroencephalogram monitoring and the indications include ： （ 1 ） altered mental status appear after seizures, acute brain injury or other unknown causes; （2） efficacy evaluation of seizure therapy is performed to confirm whether nonconvulsive seizures or NCSE is controlled monitoring for 24 to 48 hours ; （3） identification of cerebral ische- mia. Modified Salzburg consensus criteria for NCSE suggests that the diagnosis of NCSE needs the combination of clini- cal features and electroencephalograms. Suspected clinical features and signs of NCSE should last at least 10 minutes, and altered EEG of suspected NCSE should last at least 10 seconds. Benzodiazepines is the first choice of treatment in NCSE and antiepileptic drugs are selected if necessary. If the NCSE lasts longer than 60 minutes, anesthetics or other therapies may be administered.