장기간 지속된 불응성 간질 중첩증에서 고용량 valproic acid 지속주입으로 양호한 신경학적 회복을 보인 1례

High Dose Intravenous Valproic Acid for the Management of Prolonged Refractory Status Epilepticus : A Case Report of Satisfactory Neurologic Recovery

저자들은 경련을 주소로 입원 후 간질 중첩증이 발생한 8세 여아에서 phenytoin, phenobarbital 등 항경련제에 반응하지 않는 불응성 간질 중첩증에서 4 병일에 고용량 VPA 지속 주입하여 경련이 호전되고 신경학적 예후가 양호한 증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

Refractory status epilepticus (RSE) is defined as seizure activity that continues after treatment with conventional anticonvulsants. Mortality rates of range from 2% to 100%. RSE are associated with significant morbidity and high mortality as evidenced by older age of the patient, acute etiology for the seizure, no previous history of seizures, low initial Glasgow Coma Scale, and the significant duration of the RSE. An intravenous valproic acid (VPA) was suggested as a useful drug in controlling RSE. A continuous infusion VPA was an efficient method of rapidly achieving VPA concentrations in the upper region of the therapeutic range while minimizing adverse effects. A 10-year-old female suffered a generalized tonic clonic seizure that developed into refractory status epilepticus. Her Glasgow Coma Scale was deteriorated to 4. Status epilepticus was refractory to phenytoin, phenobarbital, midazolam, thiopental. After 4days of unsatisfactory control of seizure activity, high dose VPA was administered for 2 months. The clinical and electrolgraphic seizure improved and the patient has made an satisfactory neurologic recovery.