Title: Status Epilepticus

Current Evaluation and Management Pearls
题目：癫痫持续状态（目前的认识和处理要点）
Although some controversy still remains, experts have recently defined SE as 5 minutes or more of continuous seizure activity (1). In part, this definition was adopted because most seizures that last longer than 5 minutes do not stop spontaneously.

虽然仍有些争议，专家们最近定义癫痫持续状态（SE）为5分钟或更长时间的持续惊厥（1）。在某种程度上，这个定义的采用，是因为大多数超过5分钟的癫痫发作都不可能自行停止。
Non-convulsive status epilepticus is a subset of SE defined as seizure activity seen on EEG without clinical findings associated with convulsive SE. Of particular relevance to the Emergency Physician, two distinct types of NCSE have been described:
非惊厥性癫痫持续状态是癫痫持续状态的亚型，是指病人有癫痫发作脑电图改变但无抽搐的临床表现。特别与急诊医师有关的两种不同的类型包括：
(1) the ‘‘wandering confused’’ patient presenting to the ED (1,2).
(2) the acutely ill patient with severely impaired mental status, with or without subtle motor movements.
（1）到急诊科就诊的“迷茫徘徊”患者（1,2）。 （2）急性危重病人伴严重精神状态改变，没有或只有轻微的抽搐。
Benzodiazepines are emergent initial therapy. For IV therapy, lorazepam is the preferred agent; midazolam is preferred for IM therapy. In one study IM midazolam was found to be at least as effective as IV lorazepam in prehospital patients with SE (1,3).
苯二氮卓类药物用来做紧急的初始治疗。对于静脉注射治疗，劳拉西泮是首选药物；如肌注可选用咪达唑仑。在一项院前癫痫持续状态研究中发现，IM咪达唑仑与IV劳拉西泮有同样的效果（1,3）。
Following administration of benzodiazepines, urgent control antieplileptic drug (AED) therapy is required; the most common agents used are phenytoin/fosphenytoin, valproate sodium, and levetiracetam (1,4). 

At this stage, if attempts to control SE with bolus intermittent therapy fails, the patient is in refractory SE and continuous IV (cIV) AED is recommended.
在给苯二氮卓类药物之后，必须要给抗癫痫的药物（AED），最常见的AED药物为苯妥英钠/磷苯妥英钠，丙戊酸钠，左乙拉西坦（1,4）。在这个阶段，如果用间歇静脉注射未能控制癫痫持续状态，病人属于难治性SE，可考虑持续性静脉AED。
However, the use of valproate sodium, levetiracetam, and phenytoin/fosphenytoin in intermittent boluses may also be considered if they have not previously been administered.


但是，如病人以前没有用过丙戊酸钠，左乙拉西坦，苯妥英/磷苯妥英，可考虑间歇静脉推注。
In actual practice, SE experts who care for adult patients choose cIV therapy for RSE, especially midazolam and propofol; and in children, there is a reluctance to choose propofol (4). Pentobarbital is chosen later in the therapy for all ages.
在实际工作中，成人SE专家对顽固性SE通常选择持续IV治疗，尤其是咪达唑仑和异丙酚；但对儿科来说，在选择异丙酚时有一定的阻力（4）。在治疗所有年龄段病人的稍后阶段，可考虑使用巴比妥。
References 参考文献:

(1) Brophy GM, et al. Neurocrit Care 2012;17: 3-23.

(2) Shorvon S. Epilepsia 2007;48(Suppl 8):35-8.

(3) Silbergleit R, et al. N Engl J Med 2012;366: 591-600.

(4) Riviello JJ Jr. et al. Neurocrit Care 2013;18: 193-200.