Levetiracetam versus phenytoin for seizure prophylaxis in severe traumatic brain injury.
Levetiracetam versus phenytoin for seizure prophylaxis in severe traumatic brain injury.
复制标题
DOI：
10.3171/foc.2008.25.10.e3
复制
发表时间：
2008-10
影响因子：
4.1
通讯作者：
Okonkwo DO
中科院分区：
文献类型：
--
作者：
Jones KE;Puccio AM;Harshman KJ;Falcione B;Benedict N;Jankowitz BT;Stippler M;Fischer M;Sauber-Schatz EK;Fabio A;Darby JM;Okonkwo DO
目前严重创伤性脑损伤（TBI）患者的标准护理是预防性治疗苯妥英7天，以降低早期创伤后癫痫发作的风险。苯妥英改变药物代谢，引起发烧，需要治疗水平的监测。另外，左乙拉西坦（Keppra）不需要血清监测或有显著的药代动力学相互作用。在目前的研究中，作者比较了在严重脑外伤后接受苯妥英和左乙西坦单药治疗的患者的脑电图结果。前瞻性地收集了32例严重TBI后7天内接受左乙拉西坦治疗的患者的数据，并与41例接受苯妥英单药治疗的患者的历史队列数据进行了比较。如果患者出现持续昏迷、精神状态下降或癫痫发作的临床症状，则进行1小时脑电图（EEG）监测。脑电图结果分为正常和异常，异常脑电图进一步分为癫痫发作活动或癫痫发作倾向。左乙拉西坦组32例患者中有15例需要进行脑电图监测。结果正常7例，异常8例；1例有癫痫发作活动，7例有癫痫发作倾向。苯妥英组41例患者中有12例接受脑电图监测，结果均正常。左乙拉西坦和苯妥英治疗的患者癫痫发作活动发生率相当（p = 0.556）。左乙拉西坦组脑电图异常发生率较高（p = 0.003）。左乙拉西坦在预防早期创伤后癫痫发作方面与苯妥英一样有效，但在脑电图分析中，左乙拉西坦与癫痫发作倾向增加有关。
Current standard of care for patients with severe traumatic brain injury (TBI) is prophylactic treatment with phenytoin for 7 days to decrease the risk of early posttraumatic seizures. Phenytoin alters drug metabolism, induces fever, and requires therapeutic-level monitoring. Alternatively, levetiracetam (Keppra) does not require serum monitoring or have significant pharmacokinetic interactions. In the current study, the authors compare the EEG findings in patients receiving phenytoin with those receiving levetiracetam monotherapy for seizure prophylaxis following severe TBI. Data were prospectively collected in 32 cases in which patients received levetiracetam for the first 7 days after severe TBI and compared with data from a historical cohort of 41 cases in which patients received phenytoin monotherapy. Patients underwent 1-hour electroencephalographic (EEG) monitoring if they displayed persistent coma, decreased mental status, or clinical signs of seizures. The EEG results were grouped into normal and abnormal findings, with abnormal EEG findings further categorized as seizure activity or seizure tendency. Fifteen of 32 patients in the levetiracetam group warranted EEG monitoring. In 7 of these 15 cases the results were normal and in 8 abnormal; 1 patient had seizure activity, whereas 7 had seizure tendency. Twelve of 41 patients in the phenytoin group received EEG monitoring, with all results being normal. Patients treated with levetiracetam and phenytoin had equivalent incidence of seizure activity (p = 0.556). Patients receiving levetiracetam had a higher incidence of abnormal EEG findings (p = 0.003). Levetiracetam is as effective as phenytoin in preventing early posttraumatic seizures but is associated with an increased seizure tendency on EEG analysis.