癫痫持续状态药物治疗进展

Recent progress of drug therapy in status epilepticus

癫痫持续状态是神经内科急危重症,随着定义、诊断和分类的更新,其终止发作的临床操作程序也随之更新,涌现出一线和二线抗癫痫发作药物治疗癫痫持续状态的高级别证据;相继出现难治性癫痫持续状态和超级难治性癫痫持续状态的临床研究,但证据级别较低;新发难治性癫痫持续状态与免疫机制相关,可采取免疫治疗;新批准的抗癫痫发作药物如布瓦西坦、吡仑帕奈和拉科酰胺可用于难治性癫痫持续状态和超级难治性癫痫持续状态的治疗;并基于当前研究证据提出针对不同发作类型的两种不同治疗方案升级操作流程。本文综述上述研究进展,以为临床提供更优治疗方案。

Status epilepticus(SE) is a critical and emergency condition in internal medicine and neurology. Recently, the concepts, definition, and classification of SE are revised, followed by renew of the protocol of management of SE. High level of evidence for the first and second-line antiepileptic seizure medicine(ASM) are available. The new studies for treatment of refractory status epilepticus(RSE) and super-refractory status epilepticus(SRSE) are appeared but evidence for these are still very low. In newonset refractory status epilepticus(NORSE) patients without obvious cause after initial assessment, an underlying auto-immune cause was frequently found. Early immune therapy is then recommended by experts. Newer ASM such as brivaracetam(BRV), perampanel(PER), and lacosamide(LCM) may be considered to apply in RSE and SRSE. Based on current evidence, two different treatment regimens are proposed to avoid brain damages secondary to seizure activity. We are going to state above topics in this review in order to provide better therapeutic schedule.