Stan padaczkowy. Obraz kliniczny i postępowanie

• Authors: Iwona Mańka , Krystyna Pierzchała
• Languages of publication: EN PL

Abstracts

EN

Status epilepticus (SE) is a life-threatening emergency in which continuous or recurrent seizures, lasting more than 30 minutes without full recovery of consciousness between seizures occur. Seizures activity lasts more than 60 minutes and fails to respond to appropriate first-line drug treatment in refractory SE. SE is divided into convulsive and non-convulsive. It may occur in the patients with epilepsy (with low antiepileptic drug serum level), or it may be a symptom of acute (organic or metabolic) lesion of CNS. Management in SE should provide: regular functioning of the respiratory and cardiovascular systems, suppressing seizure activity, compensating metabolic disturbance and then diagnosis and casual treatment. The benzodiazepines followed by phenytoin are the first-line drug. Next, other drugs and finally general anesthesia with using barbiturate or unbarbiturate anesthetic agents. EEG performs an important part in diagnosis and monitoring of SE, especially in refractory SE, where medications are administered to achieve a burst suppression pattern on EEG. Every epileptic seizure, lasting more than 10 minutes, should be considered as a potential status epilepticus.

PL

Stan padaczkowy (SP) jest stanem zagrożenia życia, w którym występują ciągłe lub powtarzające się napady padaczkowe trwające powyżej 30 minut, pomiędzy którymi pacjent nie odzyskuje w pełni świadomości. W opornym SP aktywność napadowa utrzymuje się powyżej 60 minut i nie odpowiada na leczenie lekami 1. rzutu. SP klinicznie dzielimy na drgawkowy i niedrgawkowy. Może wystąpić u pacjentów z padaczką (przyczyną często jest niski poziom leków przeciwpadaczkowych w surowicy) lub być objawem ostrego (organicznego lub metabolicznego) uszkodzenia OUN. Postępowanie w SP polega na zapewnieniu prawidłowej czynności układów oddechowego i krążenia, opanowaniu wyładowań napadowych, wyrównaniu zaburzeń metabolicznych oraz rozpoznaniu i leczeniu przyczyny. Lekami 1. rzutu są podawane dożylnie benzodiazepiny, a następnie fenytoina. W przypadku braku efektu zaleca się inne leki, a ostatecznie znieczulenie ogólne przy użyciu barbituranów lub niebarbituranowych środków anestetycznych. Badanie EEG odgrywa ważną rolę w rozpoznaniu i monitorowaniu SP – szczególnie opornego, gdzie leki podajemy do uzyskania burst suppression pattern. Każdy napad padaczkowy trwający powyżej 10 minut powinien być traktowany jako potencjalny stan padaczkowy.

Keywords

EN

EEG; benzodiazepines; benzodiazepiny; general anesthesia; oporny stan padaczkowy; refractory status epilepticus; stan padaczkowy; status epilepticus; znieczulenie ogólne

• Journal: Aktualności Neurologiczne
• Year: 2005
• Volume: 5
• Issue: 3
• Pages: 200-208

Contributors

author

Iwona Mańka

• Katedra i Klinika Neurologii ŚAM, ul. 3-go Maja 13/15, 41-800 Zabrze, tel. (0*32) 370 45 84,

author

Krystyna Pierzchała

• Katedra i Klinika Neurologii ŚAM, ul. 3-go Maja 13/15, 41-800 Zabrze, tel. (0*32) 370 45 84

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• Document Type: article