Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany.
LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.
Epilepsia. 2019 Dec;60(12):2448-2458. doi: 10.1111/epi.16382. Epub 2019 Nov 11.
Novel treatments are needed to control treatment-resistant status epilepticus (SE). We present a summary of clinical cases where oral topiramate (TPM) was used in refractory SE (RSE) and superrefractory SE (SRSE).
A review of medical records was carried out to detect TPM administration in SE patients treated in Frankfurt and Marburg between 2011 and 2016. The primary outcome question concerned SE resolution after TPM initiation.
In total, TPM was used in 106 of 854 patients having a mean age of 67.4 ± 18.1 years, 61 of whom were female (57.5%). The median latency from SE onset to TPM initiation was 8.5 days. Patients with SE had previously failed a median of five other antiepileptic drugs. The median initial TPM dose was 100 mg/d, which was uptitrated to a median maintenance dose of 400 mg/d. Treatment with TPM was continued for a median time of 12 days. TPM was the last drug provided to 42 of 106 (39.6%) patients, with a resultant response attributed to TPM observed in 29 of 106 (27.4%) patients. A response was attributed to TPM in 21 (31.8%) of 66 RSE cases and eight (20%) of 40 SRSE cases. Treatment-emergent adverse events were attributed to TPM usage in two patients, one each with pancreatitis and hyperchloremic acidosis, and in 38 patients (35.8%), hyperammonemia was seen. Thirty-four of these patients received a combination of TPM and valproate and/or phenobarbital. The intrahospital mortality rate was 22.6% (n = 24).
The rate of SE cessation attributed to TPM treatment (27.4%) represents a relevant response given the late treatment position of TPM and the treatment latency of more than 8 days. Based on these results and in line with the findings of other case series, TPM can be considered an alternative option for treating RSE and SRSE.
需要新的治疗方法来控制治疗抵抗性癫痫持续状态（SE）。我们总结了一些病例，这些病例中使用了口服托吡酯（TPM）来治疗难治性 SE（RSE）和超难治性 SE（SRSE）。
回顾了 2011 年至 2016 年在法兰克福和马尔堡接受治疗的 SE 患者的病历，以检测 TPM 在 SE 患者中的应用。主要的问题是 TPM 开始治疗后 SE 是否得到缓解。
在总共 854 名患者中，有 106 名患者使用了 TPM，他们的平均年龄为 67.4±18.1 岁，其中 61 名为女性（57.5%）。从 SE 发作到 TPM 开始的潜伏期中位数为 8.5 天。SE 患者之前曾使用过中位数为 5 种其他抗癫痫药物治疗失败。初始 TPM 剂量中位数为 100mg/d，剂量增加至中位数维持剂量 400mg/d。TPM 的中位治疗时间为 12 天。在 106 名患者中，有 42 名（39.6%）患者最后使用了 TPM，其中 29 名（27.4%）患者对 TPM 有反应。在 66 例 RSE 病例中，有 21 例（31.8%）和 40 例 SRSE 病例中 8 例（20%）归因于 TPM 有反应。TPM 治疗后，21 例（31.8%）RSE 患者和 8 例（20%）SRSE 患者病情得到缓解。在 2 名患者中，TPM 的使用导致了治疗相关的不良事件，分别为胰腺炎和高氯性酸中毒，在 38 名患者（35.8%）中，出现了高血氨。其中 34 名患者接受了 TPM 和丙戊酸和/或苯巴比妥的联合治疗。院内死亡率为 22.6%（n=24）。
鉴于 TPM 的治疗时机较晚和超过 8 天的治疗潜伏期，归因于 TPM 治疗的 SE 停止率（27.4%）是一个重要的结果。基于这些结果，以及与其他病例系列的结果一致，TPM 可以被认为是治疗 RSE 和 SRSE 的一种替代选择。
