非痙攣性てんかん重積状態に関する諸問題—臨床と研究の進歩

Nonconvulsive Status Epilepticus; Progress in Clinical Practice and Research

本稿では，非痙攣性てんかん重積状態（NCSE）の臨床，研究上の重要な諸問題として，脳波異常の範疇，antiepileptic drug-responsive neurological deficit（ADND），malignant and critical NCSE，てんかん関連臓器機能障害（Epi-ROD），リアルタイム・ニューロモニタリング，脳神経系包括的評価スコアNeurocritical Score（Inte-grated Scale）などを取り上げ，best available evidenceを踏まえて最近の進歩をまとめる。

Abstract

Mainly after 2000, we have reported novel manifestations of nonconvulsive status epilepticus (NCSE), such as reversible protracted coma, posthyperventilation apnea, and higher brain dysfunctions, including Klüver-Bucy syndrome. In this review, we discuss the progress in clinical practice and research of NCSE with best available evidence, especially the spectrum of electroencephalographic abnormalities in NCSE, clinical manifestations of malignant NCSE, relationship between sudden unexpected death in epilepsy (SUDEP) and NCSE, and a strategy for real-time neuromonitoring. In addition, we propose some new concepts, NCSE, such as the antiepileptic drug-responsive neurological deficit (ADND), critical NCSE, fosphenytoin challenge test, epilepsy-related organ dysfunction (Epi-ROD), and a Neurocritical Score (Integrated Scale) for the comprehensive and serial evaluation of neurocritical conditions. We emphasize the need for the neuromonitoring of NCSE of broader neurological and neurocritical manifestations not only in the intensive care unit but also in the emergency room, outpatient clinic, inpatient ward, and social settings.