Faraji Gavgani Leili, Laghousi Delara, Sarbakhsh Parvin, Jahangiri Leila, Vahed Nafiseh, Hajebrahimi Sakineh
Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran.
Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
J Res Med Sci. 2023 Apr 21;28:38. doi: 10.4103/jrms.jrms_1114_21. eCollection 2023.
Febrile convulsion (FC) is the most common and preventable seizure in children. This study aimed to assess the effectiveness of the diazepam and phenobarbital for preventing recurrent FC.
In this systematic review study, literature published in English language were carefully searched in biological databases (Cochrane Library, Medline, Scopus, CINHAL, Psycoinfo, and Proquest) by February 2020.Randomized clinical trials (RCTs) and Quasi randomized trial were included in the review. Two researchers checked the literature independently. The quality of studies was assessed using the JADAD score. The potential risk for publication bias was assessed by Funnel plot and Egger's test. Meta regression test and sensitivity analysis were used to identify the reasons for heterogeneity. Given the results of assessing heterogeneity, the random effect model in RevMan5.1 software was used for meta analysis.
Four out of 17 studies had compared the effect of diazepam and phenobarbital in preventing recurrent FC. The result of the meta analysis showed that the use of diazepam in comparison with phenobarbital reduces the risk of recurrence FC by 34% (risk ratio = 0.66, 95% confidence interval [CI] = [0.36-1.21]), but the relationship was not statistically significant. In assessing the effect of diazepam or phenobarbital versus placebo, the results showed that the use of diazepam and phenobarbital has reduced the risk of recurrent FC by 49% (risk ratio = 0.51, 95% CI = [0.32-0.79]) and 37% (risk ratio = 0.63, 95% CI = [0.42-0.96)]), respectively, and these relationships were statistically significant ( < 0.05). Results of the meta regression test showed that the follow up time can be a reason for the heterogeneity between trials with the comparison of diazepam versus phenobarbital ( = 0.047, = 0.049) and Phenobarbital versus placebo ( = 0.022, = 0.016). According to the results of Funnel plot and Egger's test, there was evidence of publication bias ( = 0.0584 for comparison of diazepam vs. phenobarbital; = 0.0421 for comparison of diazepam vs. placebo; = 0.0402 for comparison of phenobarbital vs. placebo).
The results of this meta analysis indicated that preventive anticonvulsants can be useful in preventing recurrent convulsions in cases of febrile seizures.
热性惊厥（FC）是儿童中最常见且可预防的惊厥。本研究旨在评估地西泮和苯巴比妥预防FC复发的有效性。
在这项系统评价研究中，于2020年2月前在生物数据库（Cochrane图书馆、Medline、Scopus、CINHAL、Psycoinfo和Proquest）中仔细检索了英文发表的文献。纳入综述的有随机临床试验（RCTs）和半随机试验。两名研究人员独立检查文献。使用JADAD评分评估研究质量。通过漏斗图和Egger检验评估发表偏倚的潜在风险。采用Meta回归检验和敏感性分析来确定异质性的原因。鉴于评估异质性的结果，在RevMan5.1软件中使用随机效应模型进行Meta分析。
17项研究中有4项比较了地西泮和苯巴比妥预防FC复发的效果。Meta分析结果显示，与苯巴比妥相比，使用地西泮可使FC复发风险降低34%（风险比=0.66，95%置信区间[CI]=[0.36 - 1.21]），但该关系无统计学意义。在评估地西泮或苯巴比妥与安慰剂的效果时，结果显示，使用地西泮和苯巴比妥分别使FC复发风险降低了49%（风险比=0.51，95%CI=[0.32 - 0.79]）和37%（风险比=0.63，95%CI=[0.42 - 0.96]），且这些关系具有统计学意义（P<0.05）。Meta回归检验结果表明，随访时间可能是地西泮与苯巴比妥比较试验（P=0.047，I²=0.049）以及苯巴比妥与安慰剂比较试验（P=0.022，I²=0.016）之间异质性的一个原因。根据漏斗图和Egger检验的结果，存在发表偏倚的证据（地西泮与苯巴比妥比较时P=0.0584；地西泮与安慰剂比较时P=0.0421；苯巴比妥与安慰剂比较时P=0.0402）。
这项Meta分析的结果表明，预防性抗惊厥药物可用于预防热性惊厥病例中的惊厥复发。
