Prabhakar Hemanshu, Bindra Ashish, Singh Gyaninder Pal, Kalaivani Mani
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Cochrane Database Syst Rev. 2012 Aug 15(8):CD009202. doi: 10.1002/14651858.CD009202.pub2.
Failure to respond to antiepileptic drugs in uncontrolled seizure activity such as refractory status epilepticus (RSE) has led to the use of anaesthetic drugs. Coma is induced with anaesthetic drugs to achieve complete control of seizure activity. Thiopental sodium and propofol are popularly used for this purpose. Both agents have been found to be effective. However, there is substantial lack of evidence as to which of the two drugs is better in terms of clinical outcome.
To compare the efficacy, adverse effects, and short- and long-term outcomes of RSE treated with one of the two anaesthetic agents, thiopental sodium or propofol.
We searched the Cochrane Epilepsy Group Specialized Register (10 May 2012), the Cochrane Central Register of Controlled Trials (CENTRAL Issue 4 of 12, The Cochrane Library 2012), and MEDLINE (1946 to May week 1, 2012). We also searched (10 May 2012) ClinicalTrials.gov, The South Asian Database of Controlled Clinical Trials, and IndMED (a bibliographic database of Indian Medical Journals).
All randomised or quasi-randomised controlled studies (regardless of blinding) of control of RSE using either thiopental sodium or propofol.
Two review authors screened the search results and reviewed abstracts of relevant and eligible trials before retrieving the full text publications.
One study was available for review. This study was a small, single-blind, multicentre trial studying adults with RSE and receiving either propofol or thiopental sodium for the control of seizure activity (Rossetti 2011). This study showed a wide confidence interval suggesting that the drugs may differ in efficacy up to more than two-fold. There was no evidence of a difference between the drugs with respect to the outcome measures such as control of seizure activity and functional outcome at three months.
AUTHORS' CONCLUSIONS: There is lack of robust and randomised controlled evidence that can clarify the efficacy of propofol and thiopental sodium over each other in the treatment of RSE. There is a need for large, randomised controlled trials for this serious condition.
在难治性癫痫持续状态（RSE）等未得到控制的癫痫发作活动中，抗癫痫药物治疗无效促使人们使用麻醉药物。使用麻醉药物诱导昏迷以实现对癫痫发作活动的完全控制。硫喷妥钠和丙泊酚常用于此目的。已发现这两种药物均有效。然而，关于这两种药物在临床结局方面哪种更好，目前证据严重不足。
比较用硫喷妥钠或丙泊酚这两种麻醉药物之一治疗RSE的疗效、不良反应以及短期和长期结局。
我们检索了Cochrane癫痫小组专业注册库（2012年5月10日）、Cochrane对照试验中央注册库（CENTRAL，《Cochrane图书馆》2012年第12期第4卷）以及MEDLINE（1946年至2012年5月第1周）。我们还检索了（2012年5月10日）ClinicalTrials.gov、南亚对照临床试验数据库以及IndMED（印度医学期刊书目数据库）。
所有使用硫喷妥钠或丙泊酚控制RSE的随机或半随机对照研究（无论是否设盲）。
两名综述作者筛选检索结果，并在获取全文出版物之前审查相关且符合条件试验的摘要。
有一项研究可供综述。该研究是一项小型、单盲、多中心试验，研究对象为患有RSE的成年人，他们接受丙泊酚或硫喷妥钠以控制癫痫发作活动（Rossetti，2011年）。该研究显示置信区间较宽，表明这两种药物在疗效上的差异可能高达两倍以上。在癫痫发作活动控制和三个月时的功能结局等结局指标方面，没有证据表明这两种药物存在差异。
缺乏有力的随机对照证据能够阐明丙泊酚和硫喷妥钠在治疗RSE方面的相互疗效。对于这种严重疾病，需要进行大型随机对照试验。
