Gujjar Arunodaya R, Nandhagopal Ramachandiran, Jacob Poovathoor C, Al-Hashim Abdulhakeem, Al-Amrani Khalfan, Ganguly Shyam S, Al-Asmi Abdullah
Departments of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
Departments of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
Seizure. 2017 Jul;49:8-12. doi: 10.1016/j.seizure.2017.05.001. Epub 2017 May 4.
Status Epilepticus (SE) is a common medical emergency carrying a high morbidity and mortality. Levetiracetam (LEV) is a novel anticonvulsant effective against varied seizures. Few prospective studies have addressed its use in SE. We aimed to examine the efficacy of intravenous LEV in controlling SE and cluster attacks of seizures (CS), in comparison with IV phenytoin (DPH), using a prospective, randomized study design.
Adult patients with SE or CS, following an initial dose of IV benzodiazepine to control ongoing seizure, were randomized to receive either medication. Rates of seizure control over 24h, adverse effects and outcomes were compared. A logistic regression model was used to identify outcome predictors.
52 patients with SE and 63 with CS received either LEV or DPH. In the SE group, LEV was effective in18/22(82%) and DPH in 22/30(73.3%) patients in controlling seizures. Among patients with CS, LEV was effective in 31/38(81.6%) and DPH in 20/25(80%). With the use of LEV, DPH or both, SE and CS were controlled among 92% and 96% of patients respectively. Adverse events included hypotension (in 2 on DPH) and transient agitation (2 on LEV).
IV Levetiracetam controls status epilepticus or cluster seizures with an efficacy comparable to that of phenytoin. Use of these two agents consecutively may control >90% of all such conditions without resort to anaesthetic agents. Further studies should explore its efficacy in larger cohorts of epileptic emergencies.
癫痫持续状态（SE）是一种常见的医疗急症，具有较高的发病率和死亡率。左乙拉西坦（LEV）是一种新型抗惊厥药物，对多种癫痫发作有效。很少有前瞻性研究探讨其在癫痫持续状态中的应用。我们旨在采用前瞻性、随机研究设计，比较静脉注射左乙拉西坦与静脉注射苯妥英钠（DPH）在控制癫痫持续状态和癫痫丛集发作（CS）方面的疗效。
患有癫痫持续状态或癫痫丛集发作的成年患者，在静脉注射苯二氮卓类药物的初始剂量以控制正在发作的癫痫后，被随机分配接受其中一种药物治疗。比较24小时内的癫痫控制率、不良反应和结局。使用逻辑回归模型确定结局预测因素。
52例癫痫持续状态患者和63例癫痫丛集发作患者接受了左乙拉西坦或苯妥英钠治疗。在癫痫持续状态组中，左乙拉西坦对18/22（82%）的患者控制癫痫有效，苯妥英钠对22/30（73.3%）的患者有效。在癫痫丛集发作患者中，左乙拉西坦对31/38（81.6%）的患者有效，苯妥英钠对20/25（80%）的患者有效。使用左乙拉西坦、苯妥英钠或两者，分别有92%和96%的癫痫持续状态和癫痫丛集发作患者得到控制。不良事件包括低血压（2例使用苯妥英钠）和短暂性激越（2例使用左乙拉西坦）。
静脉注射左乙拉西坦控制癫痫持续状态或癫痫丛集发作的疗效与苯妥英钠相当。连续使用这两种药物可控制超过90%的此类情况，而无需使用麻醉剂。进一步的研究应探讨其在更大规模癫痫急症队列中的疗效。
