苯妥英、丙戊酸和左乙拉西坦治疗儿童癫痫持续状态的疗效比较。

Journal of epilepsy research Pub Date : 2020-12-31 eCollection Date: 2020-12-01 DOI:10.14581/jer.20011
Mudasir Nazir, Rayees Ahmad Tarray, Ravouf Asimi, Wajid Ali Syed
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引用次数: 3

摘要

背景和目的:癫痫持续状态(SE)是一种常见的儿童神经系统急症,需要立即和积极的治疗。目前,苯妥英是继苯二氮卓类药物后用于进一步预防癫痫发作的最常用药物。最近引入的其他治疗SE的药物有丙戊酸和左乙拉西坦。方法:本前瞻性随机研究纳入150例SE患儿。患者被随机分为三组(每组50人),在标准治疗的基础上接受三种抗惊厥药物中的一种。在医院监测患者的生命体征、恢复意识时间和癫痫复发情况。结果:苯妥英组24 h癫痫发作得到控制44例(88%),左乙莱西坦(LEV)组39例(78%),丙戊酸钠(VAL)组46例(92%)(p=0.115)。苯妥英、LEV、VAL组患者恢复意识的平均时间分别为122.3±45.4、120.8±42.8、75.0±30.7 min(平均±标准差)。VAL组患者意识恢复较苯妥英和LEV组患者早(pp=0.0032)。结论:在我们的研究中,我们发现静脉LEV和静脉VAL都是安全有效的。主要转归24小时癫痫复发率三组比较差异无统计学意义(p>0.05)。1周癫痫复发率差异无统计学意义。然而,VAL组3个月恢复意识的时间和癫痫复发明显少于VAL组(p
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Comparative Efficacy of IV Phenytoin, IV Valproate, and IV Levetiracetam in Childhood Status Epilepticus.

Comparative Efficacy of IV Phenytoin, IV Valproate, and IV Levetiracetam in Childhood Status Epilepticus.

Background and purpose: Status epilepticus (SE) is a common pediatric neurological emergency that requires immediate and vigorous management. Currently, phenytoin is the most common agent used in the setting of SE following benzodiazepine for further seizure prevention. Other drugs recently introduced for management of SE are valproic acid and levetiracetam.

Methods: This prospective randomized study included 150 pediatric patients admitted as SE. Patients were randomized into three equal groups (50 each) to receive one of the three anticonvulsants in addition to standard treatment. Patients were monitored in hospital regarding their vitals, time to regain consciousness, and seizure recurrence.

Results: At 24 hours seizures were controlled in 44 patients (88%) in phenytoin group, 39 patients (78%) in levetiracetam (LEV) group and 46 patients (92%) in valproate (VAL) group (p=0.115). The mean time to regain consciousness in phenytoin, LEV and VAL groups was 122.3±45.4, 120.8±42.8, and 75.0±30.7 minutes (mean±standard deviation) respectively. Patients in VAL group regained consciousness earlier than both phenytoin and LEV group patients (p<0.0001). At 3 months follow-up, seven (14.28%) out of 49 patients in phenytoin group, 14 (28.57%) out of 49 in LEV group and two (4%) out of 50 patients in VAL group had a seizure recurrence (p=0.0032).

Conclusions: In our study we found that both IV LEV and IV VAL safe and efficacious. The primary outcome, seizure recurrence at 24 hours, did not show a statistically significant difference in three groups (p>0.05). Also, seizure recurrence at 1 week did not reach a statistically significant difference. However, time to regain consciousness and seizure recurrence at 3 months was significantly less in VAL group (p<0.05).

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