Redecker Juliane, Wittstock Matthias, Benecke Reiner, Rösche Johannes
Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany.
Epilepsy Behav. 2015 Aug;49:351-3. doi: 10.1016/j.yebeh.2015.04.038. Epub 2015 May 8.
The preliminary data presented here shall give an impression on how different criteria for the identification of an antiepileptic drug (AED) with a possible or certain treatment effect can have an influence on the results of retrospective case series. We present a data subset from a large retrospective study which, when completed, will cover all treatment episodes of status epilepticus (SE) at the neurological department of the Universitätsmedizin Rostock from January 2010 to June 2013. We compare and contrast the results of four different efficacy criteria for the effectiveness of phenytoin (PHT), valproate (VPA), levetiracetam (LEV), and lacosamide (LCM): criterion 1 = the last AED administered before SE termination; criterion 2 = the last drug introduced into the antiepileptic therapy within 72 h before SE termination and without changes in the comedication; criterion 3 = the last drug introduced into the antiepileptic therapy or increased in dose within 24h before SE termination without changes in the comedication; and criterion 4 = the last drug introduced into the antiepileptic therapy within 72 h before SE termination, even allowing changes in the comedication. Thirty-seven treatment episodes in 32 patients (13 male and 19 female, mean age at first episode: 68 years, SD: 17) could be analyzed. In 31 episodes, at least one AED was given intravenously. Efficacy rates in the whole case series according to all four criteria were not significantly different between the four AEDs, but there was a considerable difference in the efficacy rates of each AED when evaluating them with the different efficacy criteria. Our data show that statistically significant results concerning the efficacy of different AEDs in different subtypes of SE may depend on the outcome criteria. Therefore, efficacy criteria for the effectiveness of AEDs in the treatment of SE should be standardized. This article is part of a Special Issue entitled Status Epilepticus.
本文所呈现的初步数据将让人了解，用于识别具有可能或确定治疗效果的抗癫痫药物（AED）的不同标准如何影响回顾性病例系列的结果。我们展示了一项大型回顾性研究的数据子集，该研究完成后将涵盖2010年1月至2013年6月罗斯托克大学医学中心神经科所有癫痫持续状态（SE）的治疗病例。我们比较并对比了苯妥英（PHT）、丙戊酸盐（VPA）、左乙拉西坦（LEV）和拉科酰胺（LCM）四种不同疗效标准的有效性：标准1 = SE终止前最后使用的AED；标准2 = SE终止前72小时内引入抗癫痫治疗且联合用药无变化的最后一种药物；标准3 = SE终止前24小时内引入抗癫痫治疗或增加剂量且联合用药无变化的最后一种药物；标准4 = SE终止前72小时内引入抗癫痫治疗的最后一种药物，甚至允许联合用药发生变化。对32例患者（13例男性和19例女性，首次发作时平均年龄：68岁，标准差：17）的37个治疗病例进行了分析。在31个病例中，至少静脉注射了一种AED。根据所有四个标准，整个病例系列中四种AED的有效率无显著差异，但使用不同疗效标准评估时，每种AED的有效率存在相当大的差异。我们的数据表明，关于不同AED在不同SE亚型中疗效的统计学显著结果可能取决于结局标准。因此，AED治疗SE有效性的疗效标准应标准化。本文是名为“癫痫持续状态”的特刊的一部分。
