Dow University of Health Sciences, Karachi, Pakistan.
Dr Ruth KM Pfau Civil Hospital Karachi, Karachi, Pakistan.
Eur J Neurosci. 2022 Aug;56(3):4234-4245. doi: 10.1111/ejn.15732. Epub 2022 Jun 17.
This network meta-analysis aims to compare various benzodiazepines and their route of administration using the data published exclusively in randomized controlled trials (RCTs). Two thousand two hundred sixty-three children presenting with an episode of seizure to ER or to a paramedic where they were administered a benzodiazepine as the first-line treatment were included. All the outcomes were measured for their mean with 95% CI and rank probability. The primary outcome was the number of successful seizure cessation. Secondary outcomes were the time interval between drug administration and seizure cessation, the time interval between patient arrival and seizure cessation and the number of episodes of seizure recurrence after drug administration. For the number of successful cessations, intramuscular midazolam showed the highest mean and best rank probability with a value of .881 (.065) and 57.9%, respectively. For the time of cessation, both intravenous lorazepam (IVL) and intravenous diazepam showed a mean of 3.30 (1.30) with IVL having the highest rank probability of 32%. For total time for cessation, intranasal midazolam showed the best mean and rank probability with a value of 4.3 (1.1) and 55%, respectively. Buccal midazolam showed the lowest mean with a value of .106 (.084) for rate of recurrence. Although there was no significant difference between the treatments, but based on the rank probability, IVL shows more promising results for patients who already have an established intravenous line, and for patients presenting in the ER without an intravenous line, the first line of treatment should be INM as it shows the highest rank probability in total time with second-highest successful cessation rate.
本网络荟萃分析旨在使用仅在随机对照试验 (RCT) 中发表的数据比较各种苯二氮䓬类药物及其给药途径。纳入了 2263 名因发作而到急诊室或急救人员处就诊的儿童，他们接受苯二氮䓬类药物作为一线治疗。所有结局均以均值和 95%CI 及等级概率进行测量。主要结局为癫痫发作停止的例数。次要结局为给药与癫痫发作停止之间的时间间隔、患者到达与癫痫发作停止之间的时间间隔以及给药后癫痫发作复发的例数。在成功停止发作的例数方面，肌内咪达唑仑显示出最高的均值和最佳等级概率，分别为.881（.065）和 57.9%。在停止时间方面，静脉劳拉西泮（IVL）和静脉地西泮均显示均值为 3.30（1.30），IVL 的等级概率最高为 32%。在总停止时间方面，鼻内咪达唑仑显示出最佳的均值和等级概率，分别为 4.3（1.1）和 55%。口腔咪达唑仑显示出最低的均值，复发率为.106（.084）。虽然治疗之间没有显著差异，但根据等级概率，对于已经建立静脉通路的患者，IVL 显示出更有前途的结果，对于没有静脉通路的急诊患者，一线治疗应为 INM，因为它在总时间上显示出最高的等级概率，其次是最高的成功停止率。
