Bansal Seema, Blalock Dan, Kebede Tewodros, Dean Nathan P, Carpenter Jessica L
Departments of Neurology and.
J Neurosurg Pediatr. 2014 Feb;13(2):209-15. doi: 10.3171/2013.10.PEDS13256. Epub 2013 Nov 29.
Seizure prophylaxis is used in a variety of conditions, including supratentorial intracranial hemorrhage (ICH). In adults, studies have demonstrated phenytoin as the drug of choice for seizure prophylaxis; in children, levetiracetam is often provided due to its favorable side effect profile and pharmacokinetics. This study evaluated the difference in efficacy between these treatment options.
This retrospective review included 126 patients between 1 month and 17 years of age with acute supratentorial ICH; all received seizure prophylaxis. Demographic data and outcome assessments were compared.
Seizure prophylaxis was provided with (fos)phenytoin in 40 children, levetiracetam in 61 children, and both drugs in 25 patients. Baseline characteristics of the treatment groups were similar, except that more patients treated with (fos)phenytoin had seizures on presentation. Patients treated solely with (fos)phenytoin had a higher probability of early seizures (within 7 days of ICH) compared with those treated only with LVT, controlling for relevant variables including seizures on presentation (OR 24.6, p = 0.002). Patients treated with (fos)phenytoin were more likely to need additional antiepileptic drugs for seizure control (p = 0.005). There was no significant difference in the incidence of late seizures (> 7 days after ICH) (p = 0.265). Adverse events necessitating a change in therapy were uncommon.
Levetiracetam is a reasonable alternative to (fos)phenytoin for prophylaxis of early posthemorrhagic seizures. Levetiracetam and (fos)phenytoin are well tolerated in children. Prospective studies are needed to determine superiority, optimal dosing, and impact on long-term outcomes.
癫痫预防适用于多种情况，包括幕上颅内出血（ICH）。在成人中，研究表明苯妥英是癫痫预防的首选药物；在儿童中，由于左乙拉西坦具有良好的副作用特征和药代动力学特性，常被用于癫痫预防。本研究评估了这些治疗方案在疗效上的差异。
这项回顾性研究纳入了126例年龄在1个月至17岁之间的急性幕上ICH患者；所有患者均接受了癫痫预防治疗。比较了人口统计学数据和结局评估。
40例儿童接受了（磷）苯妥英预防癫痫，61例儿童接受了左乙拉西坦预防癫痫，25例患者同时接受了这两种药物。各治疗组的基线特征相似，只是接受（磷）苯妥英治疗的患者中，更多患者在就诊时就有癫痫发作。在控制包括就诊时癫痫发作在内的相关变量后，单纯接受（磷）苯妥英治疗的患者发生早期癫痫（ICH后7天内）的概率高于仅接受左乙拉西坦治疗的患者（比值比24.6，p = 0.002）。接受（磷）苯妥英治疗的患者更有可能需要额外的抗癫痫药物来控制癫痫发作（p = 0.005）。晚期癫痫（ICH后>7天）的发生率没有显著差异（p = 0.265）。需要改变治疗的不良事件并不常见。
左乙拉西坦是（磷）苯妥英预防出血后早期癫痫的合理替代药物。左乙拉西坦和（磷）苯妥英在儿童中耐受性良好。需要进行前瞻性研究以确定其优越性、最佳剂量以及对长期结局的影响。
