Kahle Kristopher T, Barnett Sarah M, Sassower Kenneth C, Staley Kevin J
Department of Neurosurgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
J Child Neurol. 2009 May;24(5):572-6. doi: 10.1177/0883073809333526.
Neonatal seizures have devastating consequences for brain development and are inadequately treated by available antiepileptics. In neonates, gamma-aminobutyric acid (GABA) is an excitatory neurotransmitter due to elevated levels of intraneuronal chloride achieved by robust activity of the Na(+)-K(+)-2Cl( -) cotransporter (NKCC1). This depolarizing action of GABA likely contributes to the lowered seizure threshold, increased seizure propensity, and poor efficacy of GABAergic anticonvulsants among infants. The diuretic bumetanide inhibits NKCC1 and silences seizure activity in rodent models of neonatal seizures, but its effect on seizures in human neonates is unknown. Continuous electroencephalography (EEG) monitoring was used to quantify the number, duration, and frequency of seizures 2 hours before and after the administration of bumetanide in a neonate with intractable multifocal seizures. Significant reductions in mean seizure duration and frequency were noted following treatment, with no associated clinical side effects or metabolic imbalances. These results suggest bumetanide may exert antiepileptic effects in human neonates.
新生儿癫痫对脑发育具有毁灭性后果,且现有抗癫痫药物对其治疗效果不佳。在新生儿中,由于钠钾氯共转运体(NKCC1)的活跃活动使神经元内氯化物水平升高,γ-氨基丁酸(GABA)成为一种兴奋性神经递质。GABA的这种去极化作用可能导致婴儿癫痫阈值降低、癫痫发作倾向增加以及GABA能抗惊厥药疗效不佳。利尿剂布美他尼可抑制NKCC1,并使新生儿癫痫啮齿动物模型中的癫痫活动停止,但它对人类新生儿癫痫的影响尚不清楚。在一名患有顽固性多灶性癫痫的新生儿中,使用连续脑电图(EEG)监测来量化布美他尼给药前后2小时内癫痫发作的次数、持续时间和频率。治疗后平均癫痫发作持续时间和频率显著降低,且无相关临床副作用或代谢失衡。这些结果表明布美他尼可能对人类新生儿发挥抗癫痫作用。