Department of Neurology, Liverpool Hospital and The South Western Sydney Clinical School, University of New South Wales (NSW), Sydney, NSW, Australia.
Department of Neurology, Liverpool Hospital and The South Western Sydney Clinical School, University of New South Wales (NSW), Sydney, NSW, Australia; Griffith University, Southport, Queensland, Australia; Strategic Health Evaluators, Sydney, NSW, Australia.
Epilepsy Behav. 2014 Feb;31:31-3. doi: 10.1016/j.yebeh.2013.10.027. Epub 2013 Dec 10.
Carbamazepine (CBZ) is the gold standard antiepileptic drug (AED) for focal onset seizures. Despite CBZ being the benchmark AED, with readily available therapeutic drug monitoring, patients presenting with recurrent secondarily generalized tonic-clonic (or cluster) seizures or generalized tonic-clonic status epilepticus (SE) are primarily treated with other long-acting agents. The aim of the study was to examine the potential use of rectal (PR) CBZ as alternative long-acting treatment to parenteral AEDs following the termination of cluster seizures or SE with acute intravenous therapies. Oral CBZ syrup was given PR using 400-mg equivalent aliquots. Serum CBZ levels were requested after administration to confirm achievement of minimum therapeutic levels (total CBZ>20μmol·L(-1)). Where levels were subtherapeutic, the procedure was repeated using 400-mg CBZ bolus aliquots until therapeutic levels were achieved. Seven patients received PR CBZ to manage cluster seizures or SE following the initial termination of acute seizures with IV therapies including benzodiazepines. Six patients had no prior history of seizures, and 1 patient with a prior history was not taking AED therapy at the time of presentation. All patients subsequently remained seizure-free, and therapeutic CBZ levels were achieved in 6 of the 7 subjects within 5-10h of initial CBZ dosing. In conclusion, the present study reports 7 patients who were safely and effectively treated with PR CBZ, which proved to be a viable and safe alternative to parenteral AEDs for maintenance of seizure freedom.
卡马西平（CBZ）是局灶性发作性癫痫的金标准抗癫痫药物（AED）。尽管 CBZ 是基准 AED，具有现成的治疗药物监测，但出现复发性继发性全面强直阵挛（或阵挛）发作或全面强直阵挛性癫痫持续状态（SE）的患者主要接受其他长效药物治疗。本研究的目的是检查直肠（PR）CBZ 在急性静脉内治疗终止阵挛发作或 SE 后作为替代长效治疗的潜在用途。使用 400mg 当量等分物经 PR 给予 CBZ 糖浆。给药后要求测定血清 CBZ 水平，以确认达到最低治疗水平（总 CBZ>20μmol·L（-1））。如果水平低于治疗水平，则使用 400mg CBZ 推注等分物重复该程序，直到达到治疗水平。7 名患者在初始终止急性发作后接受 PR CBZ 治疗，包括苯二氮䓬类药物在内的 IV 治疗。6 名患者无癫痫发作史，1 名有癫痫发作史的患者在就诊时未服用 AED 治疗。所有患者随后均未再次发作，6 名 7 名患者中的 6 名在初始 CBZ 给药后 5-10h 内达到了治疗性 CBZ 水平。总之，本研究报告了 7 名患者，他们使用 PR CBZ 安全有效地治疗，这证明是一种可行且安全的替代静脉内 AED 治疗，以维持无癫痫发作。
