Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
Epilepsia. 2010 Jun;51(6):1078-82. doi: 10.1111/j.1528-1167.2009.02385.x. Epub 2009 Oct 20.
In this retrospective study of institutionalized patients with mental retardation, we present the efficacy and safety of sequential treatment with intrarectal diazepam (IRD) gel (Diastat) and intravenous levetiracetam (IVL) in comparison with either treatment alone for acute repetitive or prolonged seizures (ARPS). We defined ARPS as >or=3 seizures of any type within 1 h or a single seizure of any type lasting >or=3 min. Eighty-eight ARPS episodes were treated in 25 patients (14 female, age 21-72 years), with mainly symptomatic generalized epilepsy. There were no adverse events directly attributable to the administration of IRD or IVL. Seizure recurrence within 4 h of treatment, the primary outcome measure, was significantly lower after combined sequential IRD + IVL treatment (3 of 36) compared to IRD alone (6 of 24, p = 0.048) or IVL alone (10 of 28, p = 0.039). There was no statistically significant difference between the individual IRD and IVL treatments (p = 0.604). The estimated odds ratio (OR) indicated that the risk of seizure recurrence was higher after IRD or IVL monotherapy compared to combined IRD + IVL treatment. Subsequent emergency room (ER) transfers following seizure recurrence were least likely after IVL treatment (10%) compared to combined IRD + IVL (67%) or IRD (83%) treatment. These findings suggest that although IRD or IVL monotherapy is efficacious, the combination is superior in controlling ARPS in this special group of institutionalized patients. In addition, we speculate that a more reliable onset of action after IVL treatment results in rapid seizure control and fewer ER transfers, despite seizure recurrence.
在这项对机构收容智障患者的回顾性研究中，我们报告了直肠内给予地西泮凝胶（Diastat）（IRD）序贯治疗与单独静脉给予左乙拉西坦（IVL）治疗急性反复性或持续性癫痫发作（ARPS）的疗效和安全性。我们将 ARPS 定义为在 1 小时内出现 3 次或以上任何类型的癫痫发作，或任何类型的单次癫痫发作持续 3 分钟以上。25 例（14 例女性，年龄 21-72 岁）共 88 次 ARPS 发作接受了治疗，主要为症状性全面性癫痫。IRD 或 IVL 给药无直接相关的不良事件。主要观察指标为治疗后 4 小时内的癫痫复发，IRD 联合 IVL 序贯治疗（36 例中有 3 例）明显低于 IRD 单药治疗（24 例中有 6 例，p = 0.048）或 IVL 单药治疗（28 例中有 10 例，p = 0.039）。IRD 和 IVL 单药治疗之间无统计学差异（p = 0.604）。估计的比值比（OR）表明，与 IRD + IVL 联合治疗相比，IRD 或 IVL 单药治疗的癫痫复发风险更高。癫痫复发后，急诊室（ER）转院的可能性最低的是 IVL 治疗（10%），其次是 IRD + IVL 联合治疗（67%）和 IRD 治疗（83%）。这些发现表明，尽管 IRD 或 IVL 单药治疗有效，但在这种特殊的机构收容患者群体中，联合治疗在控制 ARPS 方面更具优势。此外，我们推测 IVL 治疗后起效更快，能更快地控制癫痫发作，从而减少 ER 转院，尽管癫痫复发。
