てんかん重積の評価

Diagnosing Status Epilepticus

Point

・てんかん重積におけるMRI DWIでの高信号領域は，大脳皮質中心に広がり，海馬や視床枕にも認められることがある．

・てんかん重積状態での持続脳波モニタリングでは，徐波律動，てんかん性異常波，周期性発射などさまざまな所見が認められ，特に非痙攣性てんかん重積状態での診断価値が高い．

・MRIおよび持続脳波モニタリングを用いて，できる限り早期にてんかん重積状態を診断し，速やかに治療に移ることが重要である．

　Both diffusion-weighted MRI（DWI）modalities and continuous electroencephalography（cEEG）are useful for diagnosing status epilepticus. In case 1, DWI showed hyperintense regions in the right-sided parieto-occipital cortex during peri-ictal status. Intensity of the regions normalized after left hemiparesis improved. In status epilepticus , DWI usually depicts some hyperintense regions, such as the cerebral cortex, hippocampus, and thalamic pulvinar, where ictal brain activity and its propagation are likely occur the seizure. In case 2, cEEG led to an accurate diagnosis of non-convulsive status epilepticus due to right-sided temporal contusion. Intravenous application of levetiracetam and lacosamide alleviated the clinical symptoms and electrographic seizures. Abnormal cEEG findings during status epilepticus vary from rhythmic delta activity and epileptiform and generalized periodic discharges to ictal discharges. Accurate diagnosis of status epilepticus using MRI and cEEG can offer earlier intervention, such as prompt administration of benzodiazepines, midazolam, lorazepam, ultimately resulting in a good recovery.