Addon Carbamazepine Oxcarbazine Phenytoin Valproate Primidone Phenobarbital Valproate

藥物之選擇 第一線 第二線 Add-on 部份性發作 大發作 小發作 Carbamazepine Oxcarbazine Phenytoin Valproate Primidone Phenobarbital Valproate Phenytoin Carbamazepine Ethosuximide Valproate Lamotrigine Primidone Phenobarbital Topiramate Lamotrigine Clonazepam Topiramate Vigabatrin Lamotrigine Gabapentin Levetiracetam 綱要

癲癇重積狀態 之臨床分類 ① 抽搐性癲癇重積狀態 (convulsive status epilepticus) ② 無抽搐性癲癇重積狀態 (non-convulsive status epilepticus)

Causes of Status Epilepticus in 300 Adults and 100 Pediatric Cases from the Medical college of Virginia Status Epilepticus Database Causes Withdrawal of anticonvulsants Alcohol withdrawal Anoxia Hypoxia Cerebrovascular disease Hemorrhage Metabolic disorder Trauma Infectious disorders Drug overdose Tumors Remote symptomatic Idiopathic Pediatric 18% 1% 1% 2% 10% 1% 1% 51% 2% 2% 6% 2% Adult 25% 15% 4% 12% 23% 2% 13% 3% 8% 2% 5% 19% 4%

三十天之死亡率 • 最重要的因素：持續發作的時間 • Nonprolonged SE (30 to 59 minutes) 2. 7% • Prolonged SE ( > 59 minutes) 32%

處置癲癇重積狀態 之第一步（a） • 支持性措施 – Airway + Breathing + Circulation • 診斷性措施 – Blood tests (Sugar, NH 3, e-, CBC, ABG) • 治療性措施 – 點滴(N/S) + EKG Monitor +/- Oximeter

抽搐性癲癇重積 狀態之藥物治療 第一線 第二線 Drug IV Loading dose Maintenance Ativan (lorazepam) 2 mg/1 ml Vial 2 mg IV for 2 min (may repeat x I after 5 min) None Diazepam (Valium) 10 mg/2 ml Amp 10 mg IV for 2 min (may repeat x I after 5 min) None Phenytoin (Dilantin) 250 mg/5 ml Amp 18~20 mg/kg (May added up to 25~30 mg/kg) at 25~50 mg/min 5 mg/kg/day 第三線 Midazolam (Dormicum) 5 mg/ml Amp or 0. 2 mg/kg (10 mg IV for 4 15 mg/3 ml/ Amp min) 0. 1~0. 4 mg/kg/hr for 12~24 hours Phenobarbital (Luminal) 100 mg/1 ml Amp 20 mg/kg at 50~100 mg/min None Propofol (Diprivan) 200 mg/20 ml Amp 1~2 mg/kg for 5 min 5~10 mg/kg/hr initially, then 1~3 mg/kg/hr

Midazolam (Dormicum®) • Loading dose: 0. 2 mg/kg IV at 4 mg/min • Continuous infusion: 0. 1~0. 4 mg/kg/h • 10~15 mg IM (when other access impossible) • Intubation and pressor support are necessary

Propofol (Diprivan®) • • Loading dose: 2 mg/kg IV Maintenance dose： 1 to 10 mg/kg/h Onset of action in 3~5 min Duration of action is only 5 ~10 min after it has been stopped • Respiratory depression, hypotension & infection are very common during prolonged infusions