Zeiler F A, Teitelbaum J, Gillman L M, West M
Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada,
Neurocrit Care. 2014 Jun;20(3):502-13. doi: 10.1007/s12028-013-9939-6.
Refractory status epilepticus (RSE) poses significant challenge, with a variety of novel therapeutics employed. Our goal was to evaluate the effectiveness of N-methyl D-aspartate (NMDA) receptor antagonists in the control of RSE. We performed a systematic review of all the literature, with all articles pulled from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to September 2013), reference lists of relevant articles, and gray literature. Two reviewers independently identified all manuscripts pertaining to the administration of NMDA receptor antagonists in humans for the purpose of controlling refractory seizures. Secondary outcome of adverse NMDA antagonist effects and patient outcome was assessed. Two reviewers independently extracted data including population characteristics, treatment characteristics, and outcomes. The strength of evidence was adjudicated using both the Oxford and GRADE methodology. Our search strategy produced a total of 759 citations. Twenty-three articles, 16 manuscripts, and seven meeting proceedings, were considered for the review with all utilizing ketamine for seizure control. Only three studies were prospective studies. Fifteen and nine studies pertained to adults and pediatrics, respectively. Across all studies, of the 110 adult patients described, ketamine was attributed to electroencephalogram seizure response in 56.5 %, with a 63.5 % response in the 52 pediatric patients described. Adverse events related to ketamine were rare. Outcomes were poorly documented in the majority of the studies. There currently exists Oxford level 4, GRADE C evidence to support the use of ketamine for refractory seizures in the adult and pediatric populations. Further prospective study of early ketamine administration is warranted.
难治性癫痫持续状态（RSE）带来了重大挑战，人们采用了多种新型治疗方法。我们的目标是评估N-甲基-D-天冬氨酸（NMDA）受体拮抗剂在控制RSE方面的有效性。我们对所有文献进行了系统综述，所有文章均来自MEDLINE、BIOSIS、EMBASE、Global Health、HealthStar、Scopus、Cochrane图书馆、国际临床试验注册平台（截至2013年9月）、相关文章的参考文献列表以及灰色文献。两名评审员独立识别了所有与在人类中使用NMDA受体拮抗剂以控制难治性癫痫发作相关的手稿。评估了NMDA拮抗剂不良作用和患者结局的次要结果。两名评审员独立提取了包括人群特征、治疗特征和结局的数据。使用牛津方法和GRADE方法来判定证据的强度。我们的检索策略共产生了759条引文。有23篇文章、16篇手稿和7篇会议记录被纳入综述，所有这些都使用氯胺酮来控制癫痫发作。只有三项研究是前瞻性研究。分别有15项和9项研究涉及成人和儿科患者。在所有研究中，在所描述的110名成年患者中，氯胺酮使脑电图癫痫发作得到缓解的比例为56.5%，在所描述的52名儿科患者中这一比例为63.5%。与氯胺酮相关的不良事件很少见。大多数研究中结局记录不佳。目前有牛津4级、GRADE C级证据支持在成人和儿科人群中使用氯胺酮治疗难治性癫痫发作。有必要进一步对早期使用氯胺酮进行前瞻性研究。
