Obravnava epileptičnega statusa pri odraslih

Status epilepticus (SE) is a severe and quite common neurological emergency with high morbidity and mortality. The aetiology of SE can be symptomatic or cryptogenic (without an obvious cause). Clinically, we divide SE into 4 phases: early, established, refractory (RSE), and super-refractory SE (SRSE). Therefore, we apply a staged approach to treatment, starting with benzodiazepines, followed by more specific antiepileptic drugs in the treatment of established SE. Patients with RSE usually need treatment with general anaesthetics in the intensive care unit (ICU). Electroencephalography (EEG) is a good diagnostic method, which has proved its usefulness in some instances of SE (nonconvulsive SE, some types of focal SE, RSE, and SRSE) and is, with years and new knowledge, becoming an important part of the management and treatment of patients with SE. Despite the severe and urgent nature of the condition, an appropriate staged approach can improve the prognosis and lower the mortality rate of SE. Epileptični status (ES) je resno in pogosto nevrološko urgentno stanje z visoko obolevnostjo in smrtnostjo. Po etiološki razvrstitvi je lahko simptomatski ali kriptogeni oz. brez znanega vzroka. Klinično ga razdelimo v 4 faze: zgodnji, napredovali, refraktorni (RES) in superrefraktorni ES (SRES). Tudi zdravljenje je temu primerno stopenjsko. V prvi fazi damo benzodiazepin, nato zdravljenje nadaljujemo z bolj specifičnimi protiepileptičnimi zdravili. Ko se razvije RES, bolniki večinoma potrebujejo zdravljenje s splošnimi anestetiki v enotah intenzivne terapije (EIT). Elektroencefalografija (EEG) je dobra diagnostična metoda, ki v določenih primerih (nekonvulzivni ES, žariščni ES, RES in SRES) z novimi izkušnjami in znanjem postaja nepogrešljiva pri obravnavi bolnikov z ES. Kljub resnosti in urgentnosti stanja lahko z ustrezno obravnavo in zdravljenjem močno izboljšamo napoved izida pri bolniku in zmanjšamo smrtnost.