Wong Meghan, Siddiqi Javed
Neurosurgery, Arrowhead Regional Medical Center, Colton, USA.
Neurosurgery, Desert Regional Medical Center, Palm Springs, USA.
Cureus. 2023 Sep 1;15(9):e44547. doi: 10.7759/cureus.44547. eCollection 2023 Sep.
The administration of multiple antiepileptic drugs (AEDs) is standard practice for neurological intensive care unit (ICU) patients who cannot obtain seizure control with monotherapy. Phenytoin and levetiracetam continue to be highly utilized AEDs for ICU patients due to their efficacy and relatively low cost. However, there is no randomized control trial to date that assesses the efficacy outcomes of the concurrent use of these two medications for ICU patients in convulsive or silent status epilepticus that combats the toxicity with increasing dosages of a single drug by itself. Here, we have analyzed several studies published over the past two decades to better understand whether the concomitant use of these two medications is more efficacious in treating unremitting seizures in ICU patients. Several factors influence which AED is a better fit for ICU patients due to the complexity of their clinical state. Risk for drug interactions, increased incidence of renal and hepatic impairment, and higher need for patient monitoring are daily barriers that determine AED use. After analysis of past research, while the efficacy of concurrent use of levetiracetam and phenytoin is still not fully clear, we offer the "Arrowhead Rationale" for such dual therapy in a subset of patients at our tertiary care trauma and stroke center in Southern California.
对于单药治疗无法控制癫痫发作的神经重症监护病房（ICU）患者，联合使用多种抗癫痫药物（AEDs）是标准治疗方法。苯妥英钠和左乙拉西坦因其疗效和相对较低的成本，仍然是ICU患者广泛使用的AEDs。然而，迄今为止，尚无随机对照试验评估这两种药物同时用于ICU惊厥性或非惊厥性癫痫持续状态患者的疗效，以及通过增加单一药物剂量来对抗毒性的效果。在此，我们分析了过去二十年发表的几项研究，以更好地了解这两种药物联合使用在治疗ICU患者持续性癫痫发作方面是否更有效。由于ICU患者临床状态复杂，有几个因素会影响哪种AED更适合他们。药物相互作用风险、肾和肝损害发生率增加以及对患者监测的更高需求，都是决定AED使用的日常障碍。在分析过去的研究后，虽然左乙拉西坦和苯妥英钠联合使用的疗效仍不完全清楚，但我们在南加州的三级创伤和卒中中心为一部分患者提供了这种双重治疗的“箭头原理”。
