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首页> 外文期刊>Journal of Clinical Medicine >Treatment of Established Status Epilepticus
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Treatment of Established Status Epilepticus

机译：确立癫痫持续状态的治疗

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Status epilepticus is the most severe form of epilepsy, with a high mortality rate and high health care costs. Status epilepticus is divided into four stages: early, established, refractory, and super-refractory. While initial treatment with benzodiazepines has become standard of care for early status epilepticus, treatment after benzodiazepine failure (established status epilepticus (ESE)) is incompletely studied. Effective treatment of ESE is critical as morbidity and mortality increases dramatically the longer convulsive status epilepticus persists. Phenytoin/fosphenytoin, valproic acid, levetiracetam, phenobarbital, and lacosamide are the most frequently prescribed antiseizure medications for treatment of ESE. To date there are no class 1 data to support pharmacologic recommendations of one agent over another. We review each of these medications, their pharmacology, the scientific evidence in support and against each in the available literature, adverse effects and safety profiles, dosing recommendations, and limitations of the available evidence. We also discuss future directions including the established status epilepticus treatment trial (ESETT). Substantial further research is urgently needed to identify these patients (particularly those with non-convulsive status epilepticus), elucidate the most efficacious antiseizure treatment with head-to-head randomized prospective trials, and determine whether this differs for convulsive vs. non-convulsive ESE.
机译：癫痫持续状态是癫痫的最严重形式，具有高死亡率和高医疗费用。癫痫持续状态分为四个阶段：早期，已确立，难治性和超难治性。虽然使用苯二氮卓类药物的初始治疗已成为早期癫痫持续状态的治疗标准，但对苯二氮卓类药物衰竭（确立状态的癫痫持续状态（ESE））的治疗尚未得到充分研究。 ESE的有效治疗至关重要，因为癫痫持续性发作持续的时间越长，发病率和死亡率就会急剧增加。苯妥英/去甲苯妥英，丙戊酸，左乙拉西坦，苯巴比妥和拉考酰胺是治疗ESE的最常用处方抗癫痫药。迄今为止，尚无第1类数据支持一种药物优于另一种药物的药理学建议。我们对每种药物，它们的药理作用，在现有文献中支持和反对每种药物的科学证据，不良反应和安全性概况，给药建议以及现有证据的局限性进行了回顾。我们还将讨论未来的方向，包括已建立的癫痫持续状态治疗试验（ESETT）。迫切需要进行大量进一步研究，以鉴定这些患者（尤其是那些非惊厥性癫痫持续状态的患者），通过头对头随机前瞻性试验阐明最有效的抗癫痫治疗方法，并确定对于惊厥性与非惊厥性ESE是否有所不同。

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