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Management des refraktären und superrefraktären Status epilepticus

Management of refractory and super-refractory status epilepticus

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Zusammenfassung

Wenn ein Status epilepticus trotz des Einsatzes von intravenösen Antiepileptika bzw. Narkotika andauert, spricht man vom „refraktären“ bzw. „superrefraktären“ Status epilepticus (RSE, SRSE). Die prolongierte Anfallsaktivität geht besonders bei generalisierten tonisch-klonischen Anfallsformen mit neuronalen Schäden, systemischen Komplikationen und damit mit einer Sterblichkeit bis zu 50 % einher. Zur Statusdurchbrechung stehen mehrere „Ultima-Ratio“-Interventionen medikamentöser und nichtmedikamentöser Art zur Verfügung. Deren Evidenzbasierung ist jedoch gering, weil die Effektivität der Maßnahmen fast nur aus Kasuistiken und Fallserien abgeleitet wurde. Im Einzelfall ist auch nach mehrmonatiger SRSE-Dauer ein gutes Outcome möglich.

Abstract

If status epilepticus continues despite the use of intravenous antiepileptic drugs or narcotics, it is called “refractory” or “super-refractory” status epilepticus (RSE, SRSE). Prolonged seizure activity is associated with neuronal damage, systemic complications and mortality rates of up to 50%, especially in generalized tonic clonic seizure types. In order to terminate the status, several rescue interventions with drugs and other measures are available. However, their evidence base is low because the effectiveness of the measures was almost exclusively derived from case reports and case series. In individual cases, a good outcome is possible even after several months of ongoing SRSE.

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Authors and Affiliations

  1. Klinik für Neurologie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Breslauer Str. 201, 90471, Nürnberg, Deutschland

    Frank Erbguth

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Correspondence to Frank Erbguth.

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Interessenkonflikt

F. Erbguth hat im Zusammenhang mit dem Thema Vortrags- und Beraterhonorare von den Antikonvulsivaherstellern Desitin Pharma und UCB Pharma erhalten.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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F. J. Erbguth, Nürnberg

M. Grond, Siegen

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Erbguth, F. Management des refraktären und superrefraktären Status epilepticus. Med Klin Intensivmed Notfmed 114, 628–634 (2019). https://doi.org/10.1007/s00063-019-00610-0

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  • DOI: https://doi.org/10.1007/s00063-019-00610-0

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