Department of Pediatrics, Kartal Dr. Lütfi Kırdar City Hospital, University of Health Science, Istanbul, Turkey.
Childs Nerv Syst. 2022 Jul;38(7):1357-1364. doi: 10.1007/s00381-022-05543-2. Epub 2022 Apr 30.
Phenytoin is one of the most used antiepileptic drugs (AEDs), but it has serious potential side effects and drug interactions. Although studies have shown levetiracetam to have a much lower side-effect profile, its efficacy when compared with phenytoin is debatable. In our study, we aimed to determine the factors that cause seizure recurrence and to compare the efficacy of levetiracetam and phenytoin in the treatment of convulsive status epilepticus (CSE) and acute repetitive seizures (ARS).
In this study, 185 patients diagnosed with CSE or ARS and aged between 1 month and 18 years who received intravenous levetiracetam or phenytoin as a second-line AED were retrospectively evaluated.
A total of 185 patients were included in the study, 85 (45.9%) girls and 100 (54.1%) boys.While 54.1% (n = 100) of the patients were given phenytoin, levetiracetam was administered to 45.9% (n = 85) of them. The rates of cessation of seizure and prevention of seizure recurrence for 24 h were 84% for phenytoin and 78.8% for levetiracetam, without a significant difference (p > 0.05). Having active seizures on admission to the emergency department and an age of < 36 months were significantly related to seizure recurrence (p < 0.01).
Our results support that the intravenous administration of levetiracetam as the second-line treatment for CSE and ARS in children is as effective as the intravenous administration of phenytoin.
苯妥英是最常用的抗癫痫药物（AEDs）之一，但它有严重的潜在副作用和药物相互作用。虽然研究表明左乙拉西坦的副作用谱要低得多，但它与苯妥英的疗效存在争议。在我们的研究中，我们旨在确定导致癫痫发作复发的因素，并比较左乙拉西坦和苯妥英治疗惊厥性癫痫持续状态（CSE）和急性反复性发作（ARS）的疗效。
本研究回顾性评估了 185 名诊断为 CSE 或 ARS 且年龄在 1 个月至 18 岁之间的患者，他们接受了静脉内左乙拉西坦或苯妥英作为二线 AED。
共有 185 名患者纳入研究，其中 85 名（45.9%）为女孩，100 名（54.1%）为男孩。54.1%（n=100）的患者给予苯妥英，45.9%（n=85）的患者给予左乙拉西坦。苯妥英组 24 小时内停止发作和预防发作复发的比例为 84%，左乙拉西坦组为 78.8%，差异无统计学意义（p>0.05）。急诊科就诊时仍有癫痫发作和年龄<36 个月与癫痫复发显著相关（p<0.01）。
我们的结果支持在儿童中，静脉内给予左乙拉西坦作为 CSE 和 ARS 的二线治疗与静脉内给予苯妥英一样有效。
