在资源有限的情况下，经鼻胃管口服抗癫痫药物治疗iv -地西泮耐药癫痫持续状态：一项观察性研究

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research Pub Date : 2025-03-12 DOI:10.1016/j.eplepsyres.2025.107544

Fitri Octaviana , Adrian Ridski Harsono , Winnugroho Wiratman , Luh Ari Indrawati , Astri Budikayanti

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引用次数: 0

摘要

尽管有新的抗癫痫药物（ASM），但癫痫持续状态（SE）仍然与高死亡率相关。三分之一的病例出现苯二氮卓类药物耐药性。在印度尼西亚，静脉注射抗痉挛药物的可用性有限，这意味着使用口服抗痉挛药物治疗SE是不可避免的。本研究旨在确定口服左乙拉西坦、托吡酯和丙戊酸制剂是否能成功终止地西泮耐药SE。该前瞻性队列研究于2021年6月至2023年3月在Dr. Cipto Mangunkusumo国立医院进行。年龄大于18岁的SE患者，在安定后服用二线口服asm达到临床明显的癫痫停止。最后一次癫痫发作后24 h评估血浆asm水平。记录了人口统计学、临床特征、癫痫成功终止的百分比以及癫痫终止的持续时间。结果53名受试者中，33名、15名和5名受试者分别服用左乙拉西坦、托吡酯和丙戊酸。其中26例（79 %），15例（100 %）和4例（80 %）癫痫发作终止。左乙西坦、托吡酯和丙戊酸口服制剂终止临床明显癫痫发作所需的中位剂量分别为23 mg/kg、6 mg/kg和20 mg/kg。托吡酯组癫痫发作终止时间明显延长。左乙拉西坦、托吡酯和丙戊酸的中位血浆水平（µg/ml）在一次二线ASM终止的受试者中分别为18.3、9.5和43.2。左乙拉西坦、托吡酯和丙戊酸组的30天死亡率分别为15 %、53 %和40 %。结论在资源有限且无法获得静脉制剂的情况下，口服抗痉挛药物是治疗耐地西泮性SE的可行选择。

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Use of oral anti-seizure medication via nasogastric tube to treat IV-diazepam resistant status epilepticus in a setting with limited resources: An observational study

Introduction

Despite the availability of new antiseizure medications (ASM), status epilepticus (SE) is still associated with a high mortality rate. One third of cases present with benzodiazepine resistance. The availability of intravenous ASMs in Indonesia is limited, meaning that the use of oral ASMs to treat SE is unavoidable. This study aimed to determine whether oral formulations of levetiracetam, topiramate, and valproic acid could successfully terminate diazepam-resistant SE.

Methods

This prospective cohort study was conducted at Dr. Cipto Mangunkusumo National Hospital between June 2021 and March 2023. Patients with SE aged over 18 years, who achieved clinically apparent seizure cessation with second-line oral ASMs following diazepam, were enrolled. Plasma levels of ASMs were assessed 24 h after the last seizure. Demography, clinical characteristics, and the percentage of successful seizure termination was recorded, as well as duration of seizure termination.

Results

Of the 53 participants, 33, 15, and 5 subjects were administered levetiracetam, topiramate, and valproic acid respectively. Of these, 26 (79 %), 15 (100 %), and 4 (80 %) achieved seizure termination. The median dose required to terminate clinically apparent seizures for oral formulations of levetiracetam, topiramate, and valproic acid were 23 mg/kg, 6 mg/kg, and 20 mg/kg. Seizure termination duration was significantly longer in the topiramate group. Median plasma levels (µg/ml) for levetiracetam, topiramate, and valproic acid among subjects who achieved seizure termination with one second-line ASM were 18.3, 9.5, and 43.2. The 30-day mortality rate among subjects administered levetiracetam, topiramate, and valproic acid, was 15 %, 53 %, and 40 %, respectively.

Conclusion

Oral ASMs can be a viable option for the treatment of diazepam-resistant SE in settings with limited resources, where intravenous formulations are not attainable.

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来源期刊

Epilepsy Research 医学-临床神经学

CiteScore

0.10

自引率

4.50%

发文量

143

审稿时长

62 days

期刊介绍： Epilepsy Research provides for publication of high quality articles in both basic and clinical epilepsy research, with a special emphasis on translational research that ultimately relates to epilepsy as a human condition. The journal is intended to provide a forum for reporting the best and most rigorous epilepsy research from all disciplines ranging from biophysics and molecular biology to epidemiological and psychosocial research. As such the journal will publish original papers relevant to epilepsy from any scientific discipline and also studies of a multidisciplinary nature. Clinical and experimental research papers adopting fresh conceptual approaches to the study of epilepsy and its treatment are encouraged. The overriding criteria for publication are novelty, significant clinical or experimental relevance, and interest to a multidisciplinary audience in the broad arena of epilepsy. Review articles focused on any topic of epilepsy research will also be considered, but only if they present an exceptionally clear synthesis of current knowledge and future directions of a research area, based on a critical assessment of the available data or on hypotheses that are likely to stimulate more critical thinking and further advances in an area of epilepsy research.