Czapiński P, Terczyński A
Kliniki Neurologii Collegium Medicum UJ, Krakowie.
Neurol Neurochir Pol. 1998 Jan-Feb;32(1):11-22.
Despite progress in controlling status epilepticus (SE), a search is still in progress for a drug--a single agent--that would successfully and safely interrupt this life-threatening situation. Valproate (VPA) has been used in control of SE since the 1970s, yet only in the late 1980s was VPA first administered intravenously, with good results. Twenty adult patients in acute or static SE with generalized tonic-clonic seizures (GTCS) or simple partial motor seizures were administered VPA (Depakine Injectable 400 mg, Sanofi Winthrop) in a bolus dose of 15 mg/kg body weight and then 30 min later as a continuous infusion of 1 mg/kg/h for 24 h. The therapeutic effect was evaluated depending on the type of SE, its aetiology and the time lapse between seizure onset and drug administration. Response latency time (time between drug administration and seizure cessation) was considered as index of therapy success. SE was interrupted in < 30 min in 80% of cases (88.8% of patients with GTCS and 72.7% of those with partial simple motor seizures). A better effect was achieved in patients with static SE and in patients in whom SE lasted < 3 h before treatment. In 60% of patients with interrupted SE, the response latency time was < 20 min. The results indicate high success of VPA in SE control.
尽管在控制癫痫持续状态(SE)方面取得了进展,但仍在寻找一种能够成功且安全地中断这种危及生命状况的药物——单一药物。自20世纪70年代以来,丙戊酸盐(VPA)一直用于控制SE,但直到20世纪80年代末VPA才首次静脉给药,并取得了良好效果。对20例患有急性或静止性SE且伴有全身强直阵挛性发作(GTCS)或单纯部分性运动性发作的成年患者,静脉推注15mg/kg体重的VPA(德巴金注射剂400mg,赛诺菲·温思罗普公司生产),30分钟后以1mg/kg/h的速度持续输注24小时。根据SE的类型、病因以及发作开始与给药之间的时间间隔来评估治疗效果。将反应潜伏时间(给药至癫痫发作停止的时间)视为治疗成功的指标。80%的病例(88.8%的GTCS患者和72.7%的单纯部分性运动性发作患者)在<30分钟内SE被中断。静止性SE患者以及治疗前SE持续<3小时的患者取得了更好的效果。在60%的SE被中断的患者中,反应潜伏时间<20分钟。结果表明VPA在控制SE方面成功率很高。