Departments of Pharmacy and Emergency Medicine University of California San Francisco, San Francisco, CA.
Department of Neurology, University of Virginia, Charlottesville, VA.
Ann Emerg Med. 2022 Sep;80(3):194-202. doi: 10.1016/j.annemergmed.2022.04.020. Epub 2022 Jun 17.
We describe a subset of patients with toxin-related precipitants of seizures/status epilepticus enrolled in the Established Status Epilepticus Treatment Trial (ESETT).
The ESETT was a prospective, double-blinded, adaptive trial evaluating levetiracetam, valproate, and fosphenytoin as second-line agents in benzodiazepine-refractory status epilepticus in adults and children. The primary outcome was the absence of seizures and improvement in the level of consciousness 1 hour after study drug administration. In this post hoc analysis, the safety and efficacy of second-line agents in a subset of patients with toxin-related seizures are described.
A total of 249 adults and 229 children were enrolled in the ESETT. Toxin-related seizures occurred in 29 (11.6%) adults and 1 child (0.4%). In adults, men were more likely to have toxin-related seizures than women (25 of 145, 17.2% versus 4 of 104, 3.9%). The most common toxin-related precipitants were alcohol withdrawal and cocaine, 11(37%) of 30 patients each. Cocaine was used with other substances by most patients 10 (91%) of 11, most commonly with an opioid 7 (64%) of 11. For alcohol withdrawal-related seizures, treatment successes with levetiracetam, valproate, and fosphenytoin were 3 (100%) of 3, 3 (50%) of 6, and 1 (50%) of 2, respectively. For cocaine-related seizures, treatment success was 1 (14%) of 7 for levetiracetam, 0 (0%) of 1 for valproate, and 1 (33%) of 3 for fosphenytoin. One patient who used cocaine and an opioid received fosphenytoin and developed life-threatening hypotension.
In the ESETT, approximately 1 in 10 adult patients with status epilepticus presented with a toxin-related seizure. Alcohol withdrawal and cocaine/opioid use were the most common toxin-related precipitants. Toxin-related benzodiazepine-refractory status epilepticus was successfully treated with a single dose of second-line antiseizure medication in 42% of the patients.
我们描述了一项纳入了与毒素相关的癫痫发作/癫痫持续状态诱因的患者亚组，该亚组患者参与了既定癫痫持续状态治疗试验（ESETT）。
ESETT 是一项前瞻性、双盲、适应性试验，评估了左乙拉西坦、丙戊酸钠和磷苯妥英在成人和儿童中作为苯二氮䓬类药物难治性癫痫持续状态的二线药物。主要结局是研究药物给药后 1 小时无癫痫发作和意识水平改善。在此事后分析中，描述了与毒素相关的癫痫发作患者亚组中二线药物的安全性和疗效。
ESETT 共纳入 249 例成人和 229 例儿童。29 例（11.6%）成人和 1 例儿童（0.4%）出现了与毒素相关的癫痫发作。在成人中，男性发生与毒素相关的癫痫发作的可能性高于女性（25/145，17.2%比 4/104，3.9%）。最常见的毒素相关诱因是酒精戒断和可卡因，各有 11 例（37%）。大多数患者同时使用了其他物质与可卡因，共 11 例（91%），最常见的是与阿片类药物合用 7 例（64%）。对于酒精戒断相关的癫痫发作，左乙拉西坦、丙戊酸钠和磷苯妥英的治疗成功率分别为 3（100%）/3、3（50%）/6 和 1（50%）/2。对于可卡因相关的癫痫发作，左乙拉西坦的治疗成功率为 1（14%）/7，丙戊酸钠为 0（0%）/1，磷苯妥英为 1（33%）/3。1 例同时使用可卡因和阿片类药物的患者接受了磷苯妥英治疗，出现危及生命的低血压。
在 ESETT 中，约每 10 例成人癫痫持续状态患者中就有 1 例出现与毒素相关的癫痫发作。酒精戒断和可卡因/阿片类药物使用是最常见的毒素相关诱因。在 42%的患者中，使用二线抗癫痫药物单次剂量成功治疗了与毒素相关的苯二氮䓬类药物难治性癫痫持续状态。
