Treatment Practices and Outcomes in Continuous Spike and Wave during Slow Wave Sleep: A Multicenter Collaboration.
Treatment Practices and Outcomes in Continuous Spike and Wave during Slow Wave Sleep: A Multicenter Collaboration.
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DOI：
10.1016/j.jpeds.2021.01.032
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Chapman KE
中科院分区：
文献类型：
--
作者：
Baumer FM;McNamara NA;Fine AL;Pestana-Knight E;Shellhaas RA;He Z;Arndt DH;Gaillard WD;Kelley SA;Nagan M;Ostendorf AP;Singhal NS;Speltz L;Chapman KE
确定目前如何管理慢波睡眠（CSWS）期间的连续棘波和波形，并使用来自美国11个儿科癫痫中心的数据库比较当前治疗策略的有效性。这项回顾性研究收集了2014-2016年在11家癫痫转诊中心就诊的连续患者的基线临床特征、CSWS病因和治疗信息。治疗分为苯二氮卓类、类固醇、其他抗癫痫药物（ASM）或其他治疗。在控制基线变量的情况下，比较了治疗间的两项治疗应答指标[主治医生观察到的临床改善;和EEG改善]。在研究期间，81名儿童接受了153项治疗试验（68项苯二氮卓类药物试验，25项类固醇试验，45项ASM试验，14项其他治疗试验）。儿童最常接受苯二氮卓类药物（62%）或ASM（27%）作为一线治疗。根据基线临床变量，治疗选择没有差异，这些变量也与结局无关。在调整基线变量后，使用苯二氮卓类药物的儿童有更大的临床改善几率（OR 3.32，95%CI 1.57-7.04，p=0.002）或类固醇（OR 4.04，95%CI 1.41-11.59，p=0.01），类固醇治疗后EEG改善的几率（OR 3.36，95%CI 1.09-10.33，p=0.03）高于ASM治疗后。在美国，苯二氮卓类和ASM是CSWS最常见的初始治疗处方。我们的数据表明ASMs劣于苯二氮卓类和类固醇，并支持早期使用这些治疗。需要进行多中心前瞻性研究，严格评估治疗方案和结局。
To determine how Continuous Spike and Wave during Slow Wave Sleep (CSWS) is currently managed and to compare the effectiveness of current treatment strategies using a database from 11 pediatric epilepsy centers in the United States. This retrospective study gathered information on baseline clinical characteristics, CSWS etiology, and treatment(s) in consecutive patients seen between 2014–2016 at 11 epilepsy referral centers. Treatments were categorized as benzodiazepines, steroids, other antiseizure medications (ASMs), or other therapies. Two measures of treatment response [clinical improvement as noted by the treating physician; and EEG improvement] were compared across therapies, controlling for baseline variables. Eighty-one children underwent 153 treatment trials during the study period (68 trials of benzodiazepines, 25 of steroids, 45 of ASMs, 14 of other therapies). Children most frequently received benzodiazepines (62%) or ASMs (27%) as first line therapy. Treatment choice did not differ based on baseline clinical variables, nor did these variables correlate with outcome. After adjusting for baseline variables, children had a greater odds of clinical improvement with benzodiazepines (OR 3.32, 95%CI 1.57–7.04, p=0.002) or steroids (OR 4.04, 95%CI 1.41–11.59, p=0.01) than with ASMs and a greater odds of EEG improvement after steroids (OR 3.36, 95% CI 1.09–10.33, p=0.03) than after ASMs. Benzodiazepines and ASMs are the most frequent initial therapy prescribed for CSWS in the United States. Our data suggests that ASMs are inferior to benzodiazepines and steroids and support earlier use of these therapies. Multicenter prospective studies that rigorously assess treatment protocols and outcomes are needed.
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