Brown L A, Levin G M
Department of Pharmacy Practice, Albany College of Pharmacy, NY, USA.
Ann Pharmacother. 1998 Oct;32(10):1053-9. doi: 10.1345/aph.17367.
To provide a review of the proposed mechanism of action, clinical efficacy, adverse effects, and therapeutic considerations associated with the use of propofol in the management of patients with refractory status epilepticus.
A MEDLINE database (January 1966-April 1998) was searched for literature pertaining to status epilepticus and propofol. Additional literature was obtained from the references of selected articles identified in the search. Information from all articles published in English was considered for inclusion in the article.
Propofol is a unique, nonbarbiturate, anesthetic agent possessing anticonvulsant properties, although the exact anticonvulsant mechanism is unknown. Several case reports and two small, open, uncontrolled studies have described the efficacy of propofol in refractory status epilepticus. Most of these clinical reports discuss the utility of propofol after traditional treatment regimens have failed or are not tolerated. Initiation of propofol usually resulted in termination of seizure activity and/or electroencephalographic burst suppression within seconds that was sustained during the drug's use. Additionally, propofol was well tolerated. Advantages of propofol compared with traditional barbiturate anesthetic agents include better cardiovascular tolerability and a more favorable pharmacokinetic profile, allowing for rapid assessment of efficacy and neurologic assessment upon drug withdrawal. Propofol has been associated with a variety of neuroexcitatory adverse events such as opisthotonos, muscle rigidity, and choreoathetoid movements. Additionally, although the data are inconclusive, propofol has also been reported to cause seizures.
Propofol has shown promising results in the management of refractory status epilepticus when traditional therapies have failed or were not tolerated; however, controlled clinical trials are needed to better assess the comparative efficacy, neurologic adverse effects, and clinical outcome to better define its role in refractory status epilepticus.
综述丙泊酚用于治疗难治性癫痫持续状态的作用机制、临床疗效、不良反应及治疗注意事项。
检索MEDLINE数据库（1966年1月至1998年4月）中有关癫痫持续状态和丙泊酚的文献。通过检索选定文章的参考文献获取更多文献。纳入所有英文发表文章的信息。
丙泊酚是一种独特的非巴比妥类麻醉剂，具有抗惊厥特性，但其确切的抗惊厥机制尚不清楚。几例病例报告和两项小型、开放、非对照研究描述了丙泊酚在难治性癫痫持续状态中的疗效。这些临床报告大多讨论了丙泊酚在传统治疗方案失败或无法耐受后的应用。开始使用丙泊酚通常会在数秒内导致癫痫活动终止和/或脑电图爆发抑制，并在用药期间持续。此外，丙泊酚耐受性良好。与传统巴比妥类麻醉剂相比，丙泊酚的优势包括更好的心血管耐受性和更有利的药代动力学特征，停药后可快速评估疗效和进行神经学评估。丙泊酚与多种神经兴奋性不良事件有关，如角弓反张、肌肉强直和舞蹈手足徐动症。此外，尽管数据尚无定论，但也有报道称丙泊酚可引起癫痫发作。
当传统疗法失败或无法耐受时，丙泊酚在治疗难治性癫痫持续状态方面已显示出有前景的结果；然而，需要进行对照临床试验，以更好地评估其相对疗效、神经学不良反应和临床结局，从而更好地确定其在难治性癫痫持续状态中的作用。
