Möddel G, Bunten S, Dobis C, Kovac S, Dogan M, Fischera M, Dziewas R, Schäbitz W-R, Evers S, Happe S
Department of Neurology, University of Münster, Albert-Schweitzer-Strasse 33, 48129 Münster, Germany.
J Neurol Neurosurg Psychiatry. 2009 Jun;80(6):689-92. doi: 10.1136/jnnp.2008.145458.
The purpose of this study was to investigate the safety and efficacy of intravenous levetiracetam (LEV-iv) in refractory status epilepticus (SE). A retrospective chart review was performed on patients who received LEV-iv for treatment of SE (n = 36) and had failed at least one other antiepileptic drug. LEV-iv (median 3000 mg/day; range 1000-9000) was administered as a bolus loading (500-2000 mg per 30-60 min, n = 30) or as a continuous pump infusion (n = 6). SE was terminated in 69% ("responders"); 31% ("non-responders") remained in SE. Factors associated with failure were: dose escalation over 3000 mg/day, lack of bolus loading, treatment latency over 48 h, age over 80 years, non-convulsive SE with coma ("subtle SE"), periodic lateralised epileptiform discharges (PLEDs) on EEG, acute cerebral lesion and intubation narcosis. SE was terminated in all eight patients without brain lesion (p = 0.033), and in all seven patients with complex partial SE (p = 0.051). Outcome was favourable (ambulatory patients) in 48% (responders) compared with 0% (non-responders), and "adverse" (death or continuing coma/stupor) in 24% (responders) compared with 100% (non-responders). Mortality was 17% (responders 4%, non-responders 45%). No patient had cardiocirculatory side effects or worsening of SE. Two patients experienced nausea and vomiting during LEV-iv loading, leading to aspiration pneumonia in one. This study suggests that LEV-iv may be a safe and efficacious treatment of SE. Prospective and controlled trials are imperative to confirm these preliminary findings.
本研究旨在探讨静脉注射左乙拉西坦（LEV-iv）治疗难治性癫痫持续状态（SE）的安全性和有效性。对接受LEV-iv治疗SE（n = 36）且至少一种其他抗癫痫药物治疗失败的患者进行回顾性病历审查。LEV-iv（中位剂量3000 mg/天；范围1000 - 9000）以静脉推注负荷量给药（每30 - 60分钟500 - 2000 mg，n = 30）或持续泵输注给药（n = 6）。69%的患者SE终止（“反应者”）；31%（“无反应者”）仍处于SE状态。与治疗失败相关的因素包括：剂量增加超过3000 mg/天、未进行静脉推注负荷量、治疗延迟超过48小时、年龄超过80岁、伴有昏迷的非惊厥性SE（“轻微SE”）、脑电图上的周期性一侧性癫痫样放电（PLEDs）、急性脑损伤和插管麻醉。所有8例无脑损伤的患者SE均终止（p = 0.033），所有7例复杂部分性SE患者SE也均终止（p = 0.051）。48%（反应者）的患者结局良好（可走动患者），而无反应者为0%；24%（反应者）的患者结局“不良”（死亡或持续昏迷/昏睡），无反应者为100%。死亡率为17%（反应者4%，无反应者45%）。无患者出现心血管副作用或SE恶化。2例患者在LEV-iv负荷量给药期间出现恶心和呕吐，其中1例导致吸入性肺炎。本研究表明，LEV-iv可能是一种安全有效的SE治疗方法。必须进行前瞻性对照试验以证实这些初步发现。
