SE CPS NCSE NCSE 24 SE 1981 International League Against Epilepsy ILAE NCSE 15 CPS 5 NCSE GCSE NCSE GCSE SE NCSE NCSE NCSE NCSE

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1 外救急 Essences of Nonconvulsive Status Epilepticus Haruhiko Kishima, M.D., Ph.D., Satoru Oshino, M.D., Ph.D., and Toshiki Yoshimine, M.D., Ph.D. Key words Jpn J Neurosurg Tokyo , 2016 はじめに Gastaut nonconvulsive status epilepticus NCSE NCSE 1 5 NCSE NCSE とは status epilepticus SE generalized convulsive status epilepticus GCSE NCSE 2 NCSE complex partial seizure CPS 229

2 SE CPS NCSE NCSE 24 SE 1981 International League Against Epilepsy ILAE NCSE 15 CPS 5 NCSE GCSE NCSE GCSE SE NCSE NCSE NCSE NCSE の疫学 NCSE SE ,000 year SE SE NCSE SE CPS SE NCSE 1 NCSE の症状と原因疾患症状 NCSE CPS NCSE NCSE 16 NCSE 2 発症原因 West Dravet Panayiotopoulos 20 Angelman electrical status epilepticus in sleep Landau Kleffner Lennox Gastaut aura continua late onset de novo absence status epilepticus myoclonic jerks NCSE 22 NCSE 29 NCSE の画像 MRI MRI NCSE

3 NCSE NCSE MRI NCSE SPECT NCSE 28 NCSE FDG PET 28 脳波 NCSE NCSE 4 NCSE NCSE amplitude integrated electroencephalograpy NCSE 3 NCSE NCSE の治療 SE 17 NCSE NCSE SE 2 1 NCSE MRI 14 NCSE の予後 SE NCSE 20 8 GCSE NCSE NCSE SE ICU NCSE NCSE 231

4 Fig. 1 Continuous electroencephalography during NCSE Continuous sharp and spiked waves were observed in the fronto temporal region. 1 実際の臨床の場では救急の現場では NCSE NCSE SE 20 GCSE NCSE NCSE NCSE 1 症例提示 2 一般診療として 1 65 歳女性

CPS 2,000 mg 300 mg 200 mg F7 Fig. 1 3 12 Fig. 1 NCSE MRI T2 FLAIR Fig.

2 FLAIR MRI revealed a hyper intensity area in the right frontal lobe.

3 A Continuous electroencephalography with intracranial electrodes

5 CPS 2,000 mg 300 mg 200 mg F7 Fig Fig. 1 NCSE MRI T2 FLAIR Fig. 2 FDG PET NCSE MRI Fig. 3 NCSE NCSE NCSE Fig. 2 FLAIR MRI revealed a hyper intensity area in the right frontal lobe. NCSE まとめ NCSE NCSE A Fig. 3 A Continuous electroencephalography with intracranial electrodes during NCSE. B The distribution map of intracranial electrodes. Frequent sharp and spiked waves were observed in the electrodes marked with circles. B 233

6 COI COI COI 文献 1 Beleza P, Rocha J, Pinho J Diagnosis, etiology, and treatment of nonconvulsive status epilepticus, a semiological oriented review. Neurologist , Brophy GM, Bell R, Claassen J, Alldredge B, Bleck TP, Glauser T, Laroche SM, Riviello JJ Jr, Shutter L, Sperling MR, Treiman DM, Vespa PM Neurocritical Care Society Status Epilepticus Guideline Writing Committee Guidelines for the evaluation and management of status epilepticus. Neurocrit Care , Chong DJ, Hirsch LJ Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. J Clin Neurophysiol , Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology , Edlow JA, Rabinstein A, Traub SJ, Wijdicks EFM Diagnosis of reversible causes of coma. Lancet , Gastaut H Clinical and electroencephalographical classification of epileptic seizures. Epilepsia , Hirsch LJ, LaRoche SM, Gaspard N, Gerard E, Svoronos A, Herman ST, Mani R, Arif H, Jette N, Minazad Y, Kerrigan JF, Vespa P, Hantus S, Claassen J, Young GB, So E, Kaplan PW, Nuwer MR, Fountain NB, Drislane FW American Clinical Neurophysiology Society s standardized critical care EEG terminology 2012 version. J Clin Neurophysiol , Jafarpour S, Loddenkemper T Outcomes in pediatric patients with nonconvulsive status epilepticus. Epilepsy Behav , Kaplan PW The clinical features, diagnosis, and prognosis of nonconvulsive status epilepticus. Neurologist , Knake S, Rosenow F, Vescovi M, Oertel WH, Mueller HH, Wirbatz A, Katsarou N, Hamer HM Status Epilepticus Study Group Hessen SESGH Incidence of status epilepticus in adults in Germany a prospective, population based study. Epilepsia , Krumholz A, Sung GY, Fisher RS, Barry E, Bergey GK, Grattan LM Complex partial status epilepticus accompanied by serious morbidity and mortality. Neurology , Brain Nerve , Laccheo I, Sonmezturk H, Bhatt AB, Tomycz L, Shi Y, Ringel M, DiCarlo G, Harris D, Barwise J, Abou Khalil B, Haas KF Non convulsive status epilepticus and non convulsive seizures in neurological ICU patients. Neurocrit Care , Lhatoo SD, Alexopoulos AV The surgical treatment of status epilepticus. Epilepsia 48 Suppl , Maganti R, Gerber P, Drees C, Chung S Nonconvulsive status epilepticus. Epilepsy Behav , Brain Nerve , Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia , Rosenow F, Hamer HM, Knake S The epidemiology of convulsive and nonconvulsive status epilepticus. Epilepsia 48 Suppl , Rudin D, Grize L, Schindler C, Marsch S, Rüegg S, Sutter R High prevalence of nonconvulsive and subtle status epilepticus in an ICU of a tertiary care center a three year observational cohort study. Epilepsy Res , Shneker BF, Fountain NB Assessment of acute morbidity and mortality in nonconvulsive status epilepticus. Neurology , Shorvon S What is nonconvulsive status epilepticus, and what are its subtypes? Epilepsia 48 Suppl , Sutter R, Kaplan PW Electroencephalographic criteria for nonconvulsive status epilepticus synopsis and comprehensive survey. Epilepsia 53 Suppl , Sutter R, Kaplan PW The neurophysiologic types of nonconvulsive status epilepticus EEG patterns of different phenotypes. Epilepsia 54 Suppl , NCSE. Brain Nerve , Tanaka A, Akamatsu N, Shouzaki T, Toyota T, Yamano M, Nakagawa M, Tsuji S Clinical characteristics and treatment responses in new onset epilepsy in the elderly. Seizure , Vignatelli L, Rinaldi R, Galeotti M, de Carolis P, D Alessandro R Epidemiology of status epilepticus in a rural area of northern Italy a 2 year population based study. Eur J Neurol , Walker M, Cross H, Smith S, Young C, Aicardi J, Appleton R, Aylett S, Besag F, Cock H, DeLorenzo R, Drislane F, Duncan J, Ferrie C, Fujikawa D, Gray W, Kaplan P, Koutroumanidis M, O Regan M, Plouin P, Sander J, Scott R, Shorvon S, Treiman D, Wasterlain C, Wieshmann U Nonconvulsive status epilepticus Epilepsy Research Foundation workshop reports. Epileptic Disord , nonconvulsive status epilepticus Young GB, Jordan KG, Doig GS An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring an investigation of variables associated with mortality. Neurology ,

7 要旨 NCSE NCSE NCSE 1 脳外誌 25: ,

48 で持続静注を行い, 持続静注中の再発 (breakthrough seizure) には 1 ~2 mg/kg のボーラス追加投与を行い,12 時間おきに 0.5~1 mg/kg/ 時ずつ増量するバーストサプレッションは 12~48 時間維持する 4, 5 チアミラール ( 持続静注は適応

48 で持続静注を行い, 持続静注中の再発 (breakthrough seizure) には 1 ~2 mg/kg のボーラス追加投与を行い,12 時間おきに 0.5~1 mg/kg/ 時ずつ増量するバーストサプレッションは 12~48 時間維持する 4, 5 チアミラール ( 持続静注は適応各論 CQ8 47 CQ8 難治性けいれん重積状態に対して昏睡療法は有用か推奨 1. 難治性けいれん重積状態に対して, ミダゾラムまたはバルビツレートでの昏睡療法は有用である推奨グレード A 2. バルビツレートの場合には, 発作活動がコントロールされていると考えられるレベルである脳波でのバーストサプレッションを治療目標とするが, ミダゾラムではバーストサプレッションに到達することは難しく, 脳波上の発作消失を目標とする推奨グレード