Status Epileptikus Acil Yönetimi
Özet
Status epileptikus (SE), nöbetlerin kendiliğinden durmadığı veya uzun sürdüğü, acil müdahale gerektiren ciddi bir nörolojik durumdur. Uluslararası Epilepsi ile Mücadele Ligi (ILAE), 2015 yılında konvülzif nöbetler için 5 dakikayı (t1) tedavinin başlama süresi, 30 dakikayı (t2) ise kalıcı hasar riski sınırı olarak belirlemiştir. SE yönetimi dört evreden oluşur: Birinci evrede (0-10 dk) hastanın stabilizasyonu sağlanır ve diazepam gibi benzodiazepinler uygulanır. İkinci evrede (10-30 dk) fenitoin, valproat veya levetirasetam gibi antiepileptik ilaçlar kullanılır. Üçüncü evrede ise dirençli vakalar için midazolam, propofol gibi anestezik ajanlar devreye girer. Ayrıca motor bulgu göstermeyen non-konvülzif status epileptikus (NKSE), tanı için EEG gerektiren kritik bir alt tiptir. Tedaviye dirençli süper-dirençli vakalarda vagal sinir stimülasyonu (VSS) ve derin beyin stimülasyonu (DBS) gibi cerrahi yöntemler alternatif seçenekler olarak değerlendirilmektedir. SE'de mortalite yaş, etiyoloji ve müdahale hızıyla doğrudan ilişkilidir.
Status epilepticus (SE) is a critical neurological emergency where seizures do not terminate spontaneously or last abnormally long. In 2015, the ILAE defined two operational time points for convulsive seizures: 5 minutes (t1) as the time to initiate treatment and 30 minutes (t2) as the threshold for potential long-term consequences like neuronal damage. SE management consists of four stages: the first stage (0-10 min) involves patient stabilization and administration of benzodiazepines such as diazepam. The second stage (10-30 min) utilizes intravenous antiepileptic drugs like phenytoin, valproate, or levetiracetam. In the third stage, anesthetic agents such as midazolam or propofol are employed for refractory cases. Additionally, non-convulsive status epilepticus (NCSE), characterized by a lack of prominent motor symptoms, is a critical subtype requiring EEG for diagnosis. For super-refractory cases, surgical methods like vagal nerve stimulation (VNS) and deep brain stimulation (DBS) are considered as alternative treatments. Mortality in SE is closely related to age, etiology, and the duration of the seizure before intervention.
Referanslar
Wilson JV, Reynolds EH. Translation and analysis of a cuneiform text forming part of a Babylonian treatise on epilepsy. Med Hist. 1990, 34:185-198.
Günbey C, Topçu M. Epilepsinin tarihçesi. Kumandaş S, Canpolat M. (ed). Çocukluk Çağı Epilepsileri. 1. Baskı. Ankara: Türkiye Klinikleri; 2020. p.1-3.
Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definitionand classification of status epilepticus—report of the ILAE task force on classificationof status epilepticus. Epilepsia. 2015;56:1515–23
Tracy Glauser1, Shlomo Shinnar2, David Gloss3, Brian Alldredge4, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016 Jan-Feb; 16(1): 48-61.
Logroscino G, Hesdorffer DC, Cascino GD, Annegers JF, Bagiella E, Hauser WA. Long-term mortality after a first episode of status epilepticus. Neurology., 2002;58:537–541.
Neligan A, Shorvon SD. Prognostic factors, morbidity and mortality in tonic-clonic status epilepticus: A review. Epilepsy Res. 2011;93:1–10.
Betjemann JP, Lowenstein DH. Status epilepticus in adults. Lancet Neurol., 2015;14:615-624.
Knake S, Rosenow F, Vescovi M, et. al. Incidence of status epilepticus in adults in Germany: a prospective, population-based study. Epilepsia. 2001; 42: pp. 714-718.
Coeytaux A, Jallon P, Galobardes B, Morabia A: Incidence of status epilepticus in French-speaking Switzerland: (EPISTAR). Neurology. 2000; 55: pp. 693-697.
Vignatelli L, Tonon C, D'Alessandro R, the Bologna Group for the Study of Status Epilepticus: Incidence and short-term prognosis of status epilepticus in adults in Bologna, Italy. Epilepsia. 2003; 44: pp. 964-968.
Markus Leitingera,b,1, Eugen Trinkaa,b,c,1, Georg Zimmermanna,d, ClaudiaA.Granbichlera,e, Teia Kobulashvilia,b, Uwe Siebertc,f,g. Epidemiology of status epilepticus in adults: Apples, pears, andoranges— A critical review. Epilepsy Behav. 2020 Feb;103 (Pt A)
DeLorenzo RJ, Pellock JM, Towne AR, Boggs JG. Epidemiology of status epilepticus. JClin Neurophysiol. 1995;12:316–25
DeLorenzo RJ, Hauser WA, Towne AR, Boggs JG, Pellock JM, Penberthy L, et al. A pro-spective, population-based epidemiologic study of status epilepticus in Richmond,Virginia. Neurology. 1996;46:1029–35.
Hesdorffer DC, Logroscino G, Cascino G, Annegers JF, Hauser WA. Incidence of status epilepticus in Rochester, Minnesota, 1965–1984. Neurology. 1998;50:735–41
Hesdorffer DC, Logroscino G, Cascino G, Annegers JF, Hauser WA: Risk of unprovoked seizure after acute symptomatic seizure: effect of status epilepticus. Ann Neurol. 1998; 44: pp. 908-912.
Beniczky S, Hirsch LJ, Kaplan PW, Pressler R, Bauer G, Aurlien H, Brøgger JC, Trinka E. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia. 2013; 54(Suppl 6):28-29
A. Neligan, SD. Shorvon. The history of status epilepticus anda its treatment. Epilepsia 50(Suppl.3):56-58 2009. March. Doi:10.1111/j.1528-1167.2009.02040.x
Robert Silbergleit1, Daniel Lowenstein, Valerie Durkalski, Robin Conwit. RAMPART (Rapid Anticonvulsant Medication Prior to Arrival Trial): a double-blind randomized clinical trial of the efficacy of intramuscular midazolam versus intravenous lorazepam in the prehospital treatment of status epilepticus by paramedics. Epilepsia .2011 Oct;52 Suppl 8(Suppl 8):47-7. Doi: 10.1111/j.1528-1167. 2011.03235
Kälviäinen R. Intranasal therapies for acute seizures. Epilepsy Behav. 2015;31(49):303–6.
Lahat E, Goldman M, Barr J, Bistritzer T, Berkovitch M: Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: prospective randomised study. BMJ 2000; 321: pp. 83-86.
Epilepsi Çalışma Grubu Tanı ve Tedavi Rehberi. Status epileptikusta tedavi yaklaşımları konvülzif status epileptikus ve nonkonvülzif status epileptikus tedavisi. 2015.74-81 (Online)https://www.noroloji.org.tr/TNDData/Uploads/files/Epilepsi%202015%20G%C3%BCncellenmi%C5%9F.pdf
Prasad M, Krishman PR, Sequeira R, Al-Roomi K. Anticonvulsant therapy for status epilepticus. Cohrane Database. Syst Rev. 2014:CD00372.
Alvarez V, Januel J-M, Burnand B. Rosetti AO. Second-line status epilepticus treatment: comparison of phenytoin, valproate and levetiracetam. Epilepsia. 2011; 52 1292-6.
Yasiry Z, Shorvon SD. The relative effectiveness of five antiepileptic drugs in treatment of benzodiazepine-resistant convulsive status epilepticus: a meta-analysis of published studies. Seizure. 2014;23:167.
Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. N Engl JMed. 2019 Nov 28;381(22):2103-2113. Doi: 10.1056/NEJMoal1905795.
Fabio Minicucci, Monica Ferlisi, Francesco Brigo, Oriano Mecarelli, et al. Management of status epilepticus in adults. Position paper of the Italian League against Epilepsy. Epilepsy & Behavior.. November 2019 102(Suppl. 5):106675 Doi: 10.1016/j.yebeh.2019.106675.
Adam Strzelczyk, Johann Philipp Zöllner, Laurent M. Willems, Julie Jost et all. Lacosamide in status epilepticus: Systematic review of current evidence. Epilepsia. 2017 Jun;58(6):933-950. Doi: 10.1111/epi.13716.
Johann Sebastian Ortiz de la Rosa, Lady Diana Ladino, Paula Juliana Rodriguez, Maria Camila Rueda et all. Efficacy of lacosamide in children and adolescents with drug-resistant epilepsy and refractory status epilepticus: A systemic review. Seizure. 2018 Mar;56:34-40. Doi: 10.1016/j.seizure.2018.01.014.
Chin RF, Neville BG, Scott RC. A systematic review of the epidemiology of status epilepticus. Eur J Neurol. 2004;11:800-10
Holtkamp M, Othman J, Buchheim K, Meierkord H: Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry .2005; 76: pp.
Novy J, Logroscino G, Rossetti AO: Refractory status epilepticus: a prospective observational study. Epilepsia. 2010; 51: pp. 251-256.
Öztürk S, Kocabay G, Topçular B, Yazıcı H, Çağatay AA, Bahat G, Baykan B, Türkmen A, Yıldız A. Non-convulsive status epilepticus following antibiotic therapy as a cause of unexplained loss of consciousness in patients with renal failure.. Clin Exp Nephrol. 2009; 13:138-144.
Ebru Altındağ1, Füsun Ferda Erdoğan2, İrsel Tezer3, Çiğdem Özkara4. Çocuk ve Erişkin Status Epileptikuslu Hastaya Yaklaşım ve Erken Dönem Tedavisi. Turk J Neurol. 2017;23:155-161.
Krahl SE, Senanayake SS, Handforth A. Destruction of peripheral C-fibers does not alter subsequent vagus nerve stimulation-induced seizure suppression in rats. Epilepsia. 2001;42:586–9.
Giorgi FS, Pizzanelli C, Biagioni F, et al. The role of norepinephrine in epilepsy: from the bench to the bedside. Neurosci Biobehav Rev. 2004;28(5):507–24.
Henry TR, Bakay RA, Pennell PB, Epstein CM, Votaw JR. Brain blood-flow alterations induced by therapeutic vagus nerve stimulation in partial epilepsy: II. Prolonged effects at high and low levels of stimulation. Epilepsia. 2004;45(9):1064–70.
Vonck K, De Herdt V, Bosman T, et al. Thalamic and limbic involvement in the mechanism of action of vagus nerve stimulation, a SPECT study. Seizure. 2008;17(8):699–706.
Koo B. EEG changes with vagus nerve stimulation. J Clin Neurophysiol. 2001;18: 434–41.
Eugen Trinka a,b,c, Francesco Brigo d. Neurostimulation in the treatment of refractory and super-refractory status epilepticus. Epilepsy Behav. 2019 Dec;101(Pt B):106551. Doi: 10.1016/j.yebeh.2019.106551. Epub 2019 Oct 30.
Sibel K Velioğlu. İlaca Dirençli Epilepsisi Olan Çocuklarda Farmakolojik Olmayan Alternatif Tedavi Yaklaşımları: Vagus Sinir Stimülasyonu ve Ketojenik Diyet. Epilepsi.2014.20 (Ek 1)59-63 Doi: 10.5505/epilepsi.2014.29591.
Dibué-Adjei M, Brigo F, Yamamoto T, Vonck K, Trinka E. Vagus nerve stimulation in refractory and super-refractory status epilepticus A systematic review. Brain Stimul. 2019 12:1101–10. Doi: 10.1016/j.brs.2019.05.011.
Kwon CS, Ripa V, Al-Awar O, Panov F, Ghatan S, Jette N. Epilepsy and Neuromodulation-Randomized Controlled Trials. Brain Sci. 2018;8(4).
Michal Sobstly, Angelika Stapinska-Syniec, Marcin Rylski. Deep brain stimulation for the treatment of refractory and super-refractory status epilepticus. Seizure .2020 Oct;81:58-62. Doi:10.1016/j.seizure.2020.07.
