tonicclonic Status Epilepticus in Children广义强直阵挛性癫痫持续状态的儿童课件.pptVIP

Status epilepticus Generalized, Tonic-Clonic Status Epilepticus in Children Michael Wilson, MD Pediatric Critical Care Objectives The participant will increase her/his ability to define status epilepticus using a practical, mechanistic approach ability to list probable causes for status epilepticus in children understanding of the pathophysiologic events knowledge of treatment strategies for pediatric status epilepticus Status epilepticus (SE) presents in a multitude of forms, dependent on etiology and patient age (myoclonic, tonic, subtle, tonic-clonic, absence, complex partial etc.) Generalized, tonic-clonic SE (GCSE) is the most common form of SE The following presentation refers to generalized, tonic-clonic SE Definition International League Against Epilepsy Single seizure 30 minutes 2 or more seizures without complete recovery of consciousness between seizures Why 30 minutes ? Animal experiments in the 1970s and 1980s had shown that ... … neuronal injury could be demonstrated after 30 min of seizure activity, even while maintaining respiration and circulation Nevander G. Ann Neurol 1985;18(3):281-90. More practical: Mechanistic definition GCSE is a condition which most likely will not terminate rapidly and / or spontaneously GCSE is a condition which requires prompt intervention Lowenstein DH. Epilepsia 1999 The longer SE persists, the lower is the likelihood of spontaneous cessation the harder it is to control the higher is the risk of morbidity and mortality Bleck TP. Epilepsia 1999;40(1):S64-6 The Status Epilepticus Working Party. Arch Dis Child 2000;83(5):415-9. Typical seizure duration Children 5 years: Typical, generalized tonic-clonic seizure lasts 5 minutes Young children and infants: Paucity of data. Suggested time frame for typical tonic-clonic seizure : 10-15 minutes Reviewed in: Lowenstein DH. Its time to revise the definition of status epilepticus. Epilepsia 1999;40(1):120-2. Revised Definition Generalized,