■新发难治性癫痫持续状态(NORSE)及其发热性感染相关癫痫综合征(FIRES)的子集是具有高死亡率和发病率的破坏性临床表现。最近发表的关于治疗这些疾病的共识包括麻醉药,抗癫痫药物,抗病毒药物,抗生素,和免疫疗法。尽管有国际公认的治疗方法,相当比例的患者的结局仍然不佳.
我们使用系统评价和荟萃分析(PRISMA)指南的首选报告项目,对神经调节技术在NORSE/FIRES急性期治疗中的应用进行了系统评价。
■我们的搜索策略带来了74篇文章,其中15篇符合我们的纳入标准。共有20例患者接受了神经调节治疗。13例代表FIRES,在17例中,NORSE仍然是隐源性的。10人接受了电惊厥治疗(ECT),7人进行了迷走神经刺激(VNS),4例接受了脑深部电刺激(DBS);1例患者最初有VNS,后来有DBS.8名患者为女性,9名为儿童。20个病人中有17个,癫痫持续状态在神经调节后得到解决,三个病人死亡。
■NORSE可能有灾难性的病程,第一个治疗目标应该是尽可能快地终止癫痫持续状态。所提供的数据受到发表病例数量少和所使用的神经调节方案的可变性的限制。然而,它们显示了早期神经调节疗法的一些潜在临床益处,建议这些技术可以在FIRES/NORSE的过程中考虑。
UNASSIGNED: New-onset refractory status epilepticus (NORSE) and its subset of febrile infection-related epilepsy syndrome (FIRES) are devastating clinical presentations with high rates of mortality and morbidity. The recently published consensus on the treatment of these conditions includes anesthetics, antiseizure drugs, antivirals, antibiotics, and immune therapies. Despite the internationally accepted treatment, the outcome remains poor for a significant percentage of patients.
UNASSIGNED: We conducted a systematic review of the use of neuromodulation techniques in the treatment of the acute phase of NORSE/FIRES using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
UNASSIGNED: Our search strategy brought up 74 articles of which 15 met our inclusion criteria. A total of 20 patients were treated with neuromodulation. Thirteen cases represented FIRES and in 17 cases the NORSE remained cryptogenic. Ten had electroconvulsive therapy (ECT), seven had vagal nerve stimulation (VNS), and four had deep brain stimulation (DBS); one patient had initially VNS and later DBS. Eight patients were female and nine were children. In 17 out of 20 patients, the status epilepticus was resolved after neuromodulation, while three patients died.
UNASSIGNED: NORSE can have a catastrophic course and the first treatment goal should be the fastest possible termination of status epilepticus. The data presented are limited by the small number of published cases and the variability of neuromodulation protocols used. However, they show some potential clinical benefits of early neuromodulation therapy, suggesting that these techniques could be considered within the course of FIRES/NORSE.