Satishchandra P, Dilipkumar S, Subbakrishna D K, Sinha S
Department of Neurology, National Institute of Mental Health and NeuroSciences [NIMHANS], Bangalore, India.
Department of Biostatistics, National Institute of Mental Health and NeuroSciences [NIMHANS], Bangalore, India.
Epilepsy Res. 2014 Sep;108(7):1238-42. doi: 10.1016/j.eplepsyres.2014.04.016. Epub 2014 May 27.
To evaluate the role of intermittent prophylaxis with clobazam in the management of HWE in a long-term prospective study.
Two hundred and sixty patients [M:F - 194:66] with HWE were recruited. Patients were divided into: (a) 'HWE alone' (n=198) - received intermittent clobazam prophylaxis, 1-1½h prior to hot water head bath (group A); (b) 62 patients (20.4%) with 'HWE with spontaneous seizures were treated with continuous AEDs along with intermittent clobazam therapy (group B).
Patients (n=198) in group A was followed for mean of 17.6 ± 10.6 months (range: 3-57). One hundred and forty seven patients (74.2%) had excellent response with complete seizure freedom with clobazam therapy while 12 (6.1%) had >75% reduction in seizure frequency. Remaining 39 (19.7%) required additional standard AED along with clobazam and 18 patients among them developed spontaneous/unprovoked seizure at follow up of 6.7 ± 4.1 months. Forty five patients in group B were seizure free while on continuous AEDs.
Intermittent clobazam prophylaxis prior to head water bath might be a preferred mode of treatment of pure HWE. Additional AEDs are required if they have associated non-reflex unprovoked seizure.
在一项长期前瞻性研究中评估氯巴占间歇预防性治疗在热性惊厥附加症（HWE）管理中的作用。
招募了260例HWE患者[男:女 = 194:66]。患者被分为：(a) “单纯HWE”组（n = 198）——在热水洗头前1 - 1.5小时接受氯巴占间歇预防性治疗（A组）；(b) 62例（20.4%）“伴有自发性发作的HWE”患者接受持续抗癫痫药物（AED）治疗并联合氯巴占间歇治疗（B组）。
A组198例患者平均随访17.6 ± 10.6个月（范围：3 - 57个月）。147例（74.2%）患者对氯巴占治疗反应良好，完全无癫痫发作，而12例（6.1%）患者癫痫发作频率降低>75%。其余39例（19.7%）患者除氯巴占外还需要额外的标准AED治疗，其中18例患者在6.7 ± 4.1个月的随访中出现自发性/无诱因发作。B组45例患者在持续使用AED期间无癫痫发作。
在热水洗头前进行氯巴占间歇预防性治疗可能是单纯HWE的首选治疗方式。如果患者伴有非反射性无诱因发作，则需要额外的AED治疗。
