Prasad K, Al-Roomi K, Krishnan P R, Sequeira R
All India Institute of Medical Sciences, Neurosciences Center, Room No. 704, AIIMS, 11002 New Delhi, India.
Cochrane Database Syst Rev. 2005 Oct 19(4):CD003723. doi: 10.1002/14651858.CD003723.pub2.
Status epilepticus is a medical emergency associated with significant mortality and morbidity, which requires immediate and effective treatment.
(1) To determine whether a particular anticonvulsant is more effective or safer to use in status epilepticus compared to another and compared to placebo.(2) To delineate reasons for disagreement in the literature regarding recommended treatment regimens and to highlight areas for future research.
We searched the following electronic databases using the highly sensitive search strategy for identifying published randomised controlled trials: (1) Cochrane Epilepsy Group Specialized Register (July 2005); (2) Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2,2005); (3) MEDLINE (1966 - August 2004); (4) EMBASE (1966 - January 2003).
Randomised controlled trials of participants with premonitory, early, established or refractory status epilepticus using a truly random or quasi-random allocation of treatments were included.
Two review authors independently selected trials for inclusion, assessed trial quality and extracted data.
Eleven studies with 2017 participants were included. Few studies used the same interventions. Diazepam was better than placebo in reducing the risk of non-cessation of seizures (RR 0.73, 95% CI 0.57 to 0.92), requirement for ventilatory support (RR 0.39, 95% CI 0.16 to 0.94) or continuation of status epilepticus requiring use of a different drug or general anaesthesia (RR 0.73, 95% CI 0.57 to 0.92). Lorazepam was better than placebo for risk of non-cessation of seizures (RR 0.52, 95% CI 0.38 to 0.71) and for risk of continuation of status epilepticus requiring a different drug or general anaesthesia (RR 0.52, 95% CI 0.38 to 0.71). Lorazepam was better than diazepam for reducing risk of non-cessation of seizures (RR 0.64, 95% CI 0.45 to 0.90) and had a lower risk for continuation of status epilepticus requiring a different drug or general anaesthesia (RR 0.63, 95% CI 0.45 to 0.88). Lorazepam was better than phenytoin for risk of non-cessation of seizures (RR 0.62, 95% CI 0.45 to 0.86). Diazepam (30 mg intrarectal gel) was better than a lower dose (20 mg intrarectal gel) in premonitory status epilepticus for the risk of seizure continuation (RR 0.39, 95% CI 0.18 to 0.86).
AUTHORS' CONCLUSIONS: Lorazepam is better than diazepam or phenytoin alone for cessation of seizures and carries a lower risk of continuation of status epilepticus requiring a different drug or general anaesthesia. Both lorazepam and diazepam are better than placebo for the same outcomes. In the treatment of premonitory seizures, diazepam 30 mg in an intrarectal gel is better than 20 mg for cessation of seizures without a statistically significant increase in adverse effects. Universally accepted definitions of premonitory, early, established and refractory status epilepticus are required.
癫痫持续状态是一种与严重死亡率和发病率相关的医疗急症，需要立即进行有效治疗。
（1）确定与另一种抗惊厥药物及安慰剂相比，某一特定抗惊厥药物在治疗癫痫持续状态时是否更有效或更安全。（2）阐明文献中关于推荐治疗方案存在分歧的原因，并突出未来研究的领域。
我们使用高度敏感的检索策略搜索了以下电子数据库，以识别已发表的随机对照试验：（1）Cochrane癫痫组专业注册库（2005年7月）；（2）Cochrane对照试验中心注册库（CENTRAL）（Cochrane图书馆2005年第2期）；（3）医学索引数据库（MEDLINE）（1966年 - 2004年8月）；（4）荷兰医学文摘数据库（EMBASE）（1966年 - 2003年1月）。
纳入使用真正随机或准随机分配治疗方法的、针对有先兆、早期、确诊或难治性癫痫持续状态参与者的随机对照试验。
两位综述作者独立选择纳入试验、评估试验质量并提取数据。
纳入了11项研究，共2017名参与者。很少有研究使用相同的干预措施。地西泮在降低癫痫发作未停止的风险（相对危险度0.73，95%可信区间0.57至0.92）、通气支持需求（相对危险度0.39，95%可信区间0.16至0.94）或需要使用不同药物或全身麻醉的癫痫持续状态持续风险（相对危险度0.73，95%可信区间0.57至0.92）方面优于安慰剂。劳拉西泮在癫痫发作未停止的风险（相对危险度0.52，95%可信区间0.38至0.71）以及需要使用不同药物或全身麻醉的癫痫持续状态持续风险（相对危险度0.52，95%可信区间0.38至0.71）方面优于安慰剂。在降低癫痫发作未停止的风险（相对危险度0.64，95%可信区间0.45至0.90）方面，劳拉西泮优于地西泮，且需要使用不同药物或全身麻醉的癫痫持续状态持续风险较低（相对危险度0.63，95%可信区间0.45至0.88）。在癫痫发作未停止的风险（相对危险度0.62，95%可信区间0.45至0.86）方面，劳拉西泮优于苯妥英钠。在先兆性癫痫持续状态中，地西泮（30毫克直肠凝胶）在癫痫发作持续风险方面优于较低剂量（20毫克直肠凝胶）（相对危险度0.39，95%可信区间0.18至0.86）。
在癫痫发作停止方面，劳拉西泮优于单独使用的地西泮或苯妥英钠，且需要使用不同药物或全身麻醉的癫痫持续状态持续风险较低。在相同结局方面，劳拉西泮和地西泮均优于安慰剂。在治疗先兆性癫痫发作时，30毫克直肠凝胶的地西泮在癫痫发作停止方面优于20毫克，且不良反应无统计学意义的显著增加。需要对先兆性、早期、确诊和难治性癫痫持续状态进行普遍接受的定义。
