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გულყრა და სტატუს ეპილეპტიკუს
გულყრა და სტატუს ეპილეპტიკუს
Tea tavartkiladze
Thanks to Edward P. Sloan, MD, MPH,
FACEP
Kklinikuri istoria
37w. Mmamakaci
033
generalizebuli tonur-klonuri krunCxva
saxlSi
moixsna diazepami i/v
med; fenobarbitali, dilantini
ar icavs reJims
emerjensSi
post-iqtaluri periodi
fok.nevr cvlilebebi ar aris
travmuli dazianeba, toqsikologiuri datvirTva
ar aris
ment statusi normaluri
aReniSna ganmeorebiTi gulyra
Semdeg?
mTavari kiTxvebi
GCSE: NoN
Generalized convulsive SE
Mimdinareobs tonur-
klonuri motoruli
GCSE
aqtivobiT
NoN GCSE tipebi
Non-convulsive SE:
o Absence SE
o Complex-partial SE
• Subtle SE:
o Ggeneralizebuli konvulsiuri stat.
epileptikus
o koma, persistentuli iqtaluri periodi
o cudi prognozi (letaloba 50%)
refraqtoruli status epi.
ar eqvemdebareba pirveli rigis arCevis
preparatebiT mkurnalobas(benzo, fenitoini)
cns mZime paTologia
gvxvdeba 6-9%-Si
Subtle SE?
mkurnaloba
protokolebis, kvlevebis simcire, ar arsebobs
erTi wesi
VA Coop Study
Treiman, NEJM 1998
Lorazepam 65%,
phenobarbital 58%
Diazepam and phenytoin 56%
Phenytoin alone inferior 44%
No use of fosphenytoin
SE Review Article
• Lowenstein, NEJM 1998
• Lorazepam, phenytoin,
phenobarbital
• Midazolam an propofol i.v
gadasxmebi
mtkicebulebiTi medicina
rekomendaciis sxvadasxva done
o A (Standard): High degree of certainty
based on Class I studies
o B (Guideline): Moderate clinical certainty
based on Class II studies
o C (Option): Inconclusive certainty
based on Class III evidence, consensus
lab kvlevebi axladaRmocenebuli
gulyra
G Tu pac. gulyris Semdgomi (postiqtaluri) periodi
gagrZelda cota xans, ris Semdegac pacientis
mdgomareoba, statusi daubrunda sawyiss,
garTulebebi ar aReniSna.
Labs
• Level B recommendations:
glukoza sisxlSi
Eeleqtrolitebi
fexmZimobis testi
LP T.t kt-s Semdeg imunodeficitis
dros
Neuroimaging
axladaRmocenebuli gulyra
Level B recommendations
T.t k.t, Tu kt ver xerxdeba, pacientis
hospitalizacia an riskis Sefasebis Semdeg
ambulatoriulad viziti nevrologTan
Ddispozicia
axladaRmocenebuli gulyra
Level C recommendations
pacientebi norm. kt kvleviT, norm lab.
monacemebiT, romelTac ar aReniSnebaT fok. nevr,
cvlilebebi SesaZlebelia gaeweron emerjensidan,
nevrologis ambulatoriuli meTvalyureobis qveS
pacientebi norm. kt kvleviT, norm lab.
monacemebiT, romelTac ar aReniSnebaT fok. nevr,
cvlilebebi ar saWiroeben antiepilefsiur mkurnalobis
daniSvnas
Sz/SE:mkurnaloba
Level C recommendation
pacientebSi romlebic saWiroeben antiepilefsiur
mkurnalobas, medikamentebs viwyebT
emerjensSi
Sz/SE
romeli medikamentebi gamoviyenoT rodesac pirveli rigis
arCevis preparatebi ar arian efeqturi
Level C recommendation:
o iv: “maRali doza phenytoin-is,”
phenobarbital, valproic acid,
midazolam infuzia, pentobarbital
infuzia, an propofol infuzia.
Sz/SE: EEG
Level C recommendation:
onon-convulsive SE
osubtle convulsive SE,
oa long-acting paralytic,
o drug-induced coma.
ACEP Summary
Aar arsebobs Level A recommendation
standartul mkurnalobas ar gansazRvravs
dafuZnebulia mtkicebulebiT medicinaze
Stat SE Protocol: 0-90 Min
oTxi 30 min periodi
• 0-30 ABCs, Benzos
• 30-60 Phenytoins
• 60-90 Phenobarb,
Valproate
Stat SE Protocol: 90-120 Min
• 90-120grZeldeba
antiepilefsiuri med.
i.v. infuzia
• CT, neiro konsultacia
• ICU
• EEG monitoringi
ED Patient Management