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• W2090563902 abstract "L’état de mal convulsif généralisé franc ou larvé est un syndrome qui reflète une souffrance cérébrale focale ou diffuse. Sa prise en charge est urgente et complexe : le clinicien doit s’assurer de la réalité du diagnostic, contrôler les multiples facteurs d’agression cérébrale, interrompre les convulsions, rechercher et traiter l’étiologie. La définition de l’état de mal doit faire l’objet d’un consensus car elle est variable selon les auteurs, ce qui gêne la généralisation des résultats des essais thérapeutiques et leur appropriation par les cliniciens. Le traitement de première ligne, qui doit comporter un antiépileptique d’efficacité prolongée, est assez bien codifié, mais il persiste des difficultés dans l’application des recommandations. L’électroencéphalogramme est sous utilisé. Parfois indispensable au diagnostic (élimination d’un état de mal factice, d’une encéphalopathie postanoxique, confirmation d’un état de mal larvé), il est nécessaire à la prise en charge rationnelle de l’état de mal réfractaire. Les encéphalopathies postanoxiques, souvent confondues avec un état de mal convulsif généralisé larvé, doivent être mieux caractérisées surtout sur le plan électroencéphalographique. De nouvelles stratégies thérapeutiques doivent être évaluées, à tous les stades de l’évolution. Pour mieux cerner les facteurs pronostiques de l’état de mal convulsif, il est indispensable de stratifier les études prospectives futures sur l’âge et l’étiologie. Le pronostic fonctionnel reste très mal évalué.Overt or subtle generalized status epilepticus is a syndrome reflecting a focal or diffuse cerebral dysfunction. Its management is urgent and difficult: the diagnosis must be firmly established, seizures and other clinical and biological factors that may worsen cerebral dysfunction controlled, aetiology identified and treated. Definition of status epilepticus varies among authors, which impedes generalization of the results of the clinical trials and their acceptation by physicians. Although the first line treatment, which must include prolonged action antiepileptics, is rather well codified, difficulties persist to apply the detailed predefined management protocols. The electroencephalogram is underused, whereas it is sometimes absolutely required for diagnosis purpose (elimination of a factitious status, hypoxic-ischaemic encephalopathy, detection of a subtle generalized status epilepticus) or therapeutic purpose (rational management of refractory convulsive status epilepticus). Hypoxic-ischaemic encephalopathy, often confused with subtle generalized status epilepticus, needs to be better characterized especially its electroencephalographic patterns. First-line treatment is not consistently successful in terminating the seizures and more effective treatments are needed, particularly for refractory convulsive status epilepticus. These treatments will require rigorous evaluation through prospective controlled trials. To gain further insight into the factors that bear on the prognosis of CSE, prospective studies using standardised treatments and patient stratification on age and aetiologies are needed. Functional outcome remains poorly assessed." @default.
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• W2090563902 date "1995-01-01" @default.
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• W2090563902 title "Prise en charge d'un état de mal épileptique de l'adulte en réanimation" @default.
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• W2090563902 doi "https://doi.org/10.1016/s1164-6756(05)80554-7" @default.
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