Department of Pediatrics, Division of Neurology, CHU Saint-Justine, University of Montreal, Montreal, Canada.
Am J Emerg Med. 2012 Nov;30(9):2000-4. doi: 10.1016/j.ajem.2011.11.007. Epub 2012 Mar 3.
Fever is the most common precipitant of status epilepticus in children. Animal models suggest that only γ-aminobutyric acidic drugs are effective in the treatment of febrile seizures, but there is limited clinical evidence to support this.
The aim of this study was to determine the efficacy of phenytoin, a sodium channel blocker, in the treatment of febrile status epilepticus in children.
This study is a retrospective chart review of 56 children (62 episodes) who presented to our emergency department with febrile status epilepticus and received phenytoin. The clinical parameters were evaluated by reviewing the charts. The efficacy of phenytoin was classified into 3 categories: positive, negative, and nonevaluable response.
The primary outcome was to evaluate the efficacy rate of phenytoin; there were 9 (14.5%) of 62 episodes with a positive response, 25 (40.3%) with a negative response, and 28 (45.2%) with a nonevaluable response because phenytoin was given simultaneously with a γ-aminobutyric acidic (GABAergic) drug (P < .001). The secondary outcome was to measure the mean seizure duration for each treatment category, which were 52.8, 109.9, and 52.6 minutes, respectively (P < .01).
Phenytoin is rarely effective in controlling febrile status epilepticus. Children exposed to phenytoin have more prolonged febrile seizures, increasing the risk of brain injury.
发热是儿童癫痫持续状态最常见的诱因。动物模型表明，只有γ-氨基丁酸能药物对治疗热性惊厥有效，但临床证据有限。
本研究旨在确定苯妥英钠（一种钠离子通道阻滞剂）治疗儿童热性惊厥持续状态的疗效。
这是一项对 56 名（62 例次）因热性惊厥持续状态就诊于我院急诊科并接受苯妥英钠治疗的患儿的回顾性图表研究。通过查阅病历评估临床参数。苯妥英钠的疗效分为 3 类：有效、无效和无法评估。
主要结局是评估苯妥英钠的疗效率；有 9 例（14.5%）62 例次为有效反应，25 例（40.3%）为无效反应，28 例（45.2%）为无法评估反应，因为苯妥英钠与γ-氨基丁酸（GABAergic）药物同时使用（P<.001）。次要结局是测量每个治疗类别的平均癫痫发作持续时间，分别为 52.8、109.9 和 52.6 分钟（P<.01）。
苯妥英钠很少能有效控制热性惊厥持续状态。接触苯妥英钠的儿童热性惊厥持续时间更长，增加了脑损伤的风险。
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