From the Department of Neurology (R.W.), University of Washington, Seattle; Departments of Neurology (S.W.T., C.E.H.) and Emergency Medicine (R.S.), University of Michigan, Ann Arbor; Department of Emergency Medicine (M.K.), Irving Medical Center, Columbia University, New York, NY; Department of Public Health Sciences (J.E.), Medical University of South Carolina, Charleston; and Division of Emergency Medicine (J.C.), Children's National Medical Center, Washington, DC.
Neurology. 2021 Aug 17;97(7):e720-e727. doi: 10.1212/WNL.0000000000012414. Epub 2021 Jun 29.
To investigate whether receiving a second-line anticonvulsant medication that is part of a patient's home regimen influences outcomes in benzodiazepine-refractory convulsive status epilepticus.
Using the Established Status Epilepticus Treatment Trial data, allocation to a study drug included in the patient's home anticonvulsant medication regimen was compared to receipt of an alternative second-line study medication. The primary outcome was cessation of clinical seizures with improved consciousness by 60 minutes after study drug initiation. Secondary outcomes were seizure cessation adjudicated from medical records and adverse events. We performed inverse probability of treatment-weighted (IPTW) logistic regressions.
Of 462 patients, 232 (50%) were taking 1-2 of the 3 study medications at home. The primary outcome was observed in 39/89 (44%) patients allocated to their home medication vs 76/143 (53%) allocated to a nonhome medication (IPTW odds ratio [OR] 0.66, 95% confidence interval [CI] 0.39-1.14). The adjudicated outcome occurred in 37/89 (42%) patients vs 82/143 (57%), respectively (IPTW OR 0.52, 95% CI 0.30-0.89). There was no interaction between study levetiracetam and home levetiracetam and there were no differences in adverse events.
There was no difference in the primary outcome for patients who received a home medication vs nonhome medication. However, the retrospective evaluation suggested an association between receiving a nonhome medication and seizure cessation.
This study provides Class II evidence that for patients with refractory convulsive status epilepticus, use of a home second-line anticonvulsant compared to a nonhome anticonvulsant did not significantly affect the probability of stopping seizures.
研究在苯二氮䓬类药物难治性惊厥性癫痫持续状态患者中，接受二线抗癫痫药物治疗（该药物属于患者居家治疗方案的一部分）是否会影响结局。
利用已确立的癫痫持续状态治疗试验数据，将患者居家抗癫痫药物方案中包含的研究药物的分配与替代二线研究药物的使用进行比较。主要结局是在开始使用研究药物后 60 分钟内，临床发作停止且意识改善。次要结局是根据病历判断的发作停止和不良事件。我们进行了逆概率治疗加权（inverse probability of treatment-weighted，IPTW）逻辑回归。
在 462 名患者中，有 232 名（50%）患者居家服用 1-2 种研究药物中的 3 种。主要结局在 89 名（44%）分配至居家药物的患者和 143 名（53%）分配至非居家药物的患者中观察到（IPTW 比值比[odds ratio，OR]0.66，95%置信区间[confidence interval，CI]0.39-1.14）。在各自的组中，判定的结局分别在 89 名（42%）患者和 143 名（57%）患者中发生（IPTW OR 0.52，95% CI 0.30-0.89）。研究左乙拉西坦和居家左乙拉西坦之间没有交互作用，不良事件也没有差异。
接受居家药物和非居家药物的患者在主要结局方面没有差异。然而，回顾性评估表明，接受非居家药物与癫痫发作停止之间存在关联。
本研究提供了 II 级证据，表明对于苯二氮䓬类药物难治性惊厥性癫痫持续状态患者，与使用非居家二线抗癫痫药物相比，使用居家二线抗癫痫药物不会显著影响停止癫痫发作的概率。
