Levetiracetam Prophylaxis for Post-traumatic Brain Injury Seizures is Ineffective: A Propensity Score Analysis
Levetiracetam Prophylaxis for Post-traumatic Brain Injury Seizures is Ineffective: A Propensity Score Analysis
复制标题
左乙拉西坦预防创伤后脑损伤癫痫发作无效：倾向评分分析
DOI：
10.1007/s00268-016-3606-y
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发表时间：
2016
影响因子：
2.6
通讯作者：
T. O'keeffe
中科院分区：
文献类型：
--
作者：
B. Zangbar;M. Khalil;A. Gruessner;B. Joseph;R. Friese;N. Kulvatunyou;Julie L. Wynne;R. Latifi;P. Rhee;T. O'keeffe
严重创伤性脑损伤（TBI）后早期癫痫发作的报告发病率高达15%。使用1周苯妥英预防早期癫痫发作被认为是癫痫发作预防的标准治疗。然而，许多中心已经取代了抗惊厥药物左乙拉西坦，但没有关于这种方法疗效的良好数据。我们的假设是，左乙拉西坦的治疗是不能有效地防止早期创伤后seizure.MethodsAll创伤患者持续TBI从2007年1月至2009年12月在城市一级创伤中心进行了回顾性分析。从前瞻性收集的发病率数据库中确定癫痫发作，并从药房数据库中确定抗惊厥药使用情况。通过卡方检验、t检验和逻辑回归模型进行统计学比较。结果5551例创伤患者在研究期间发生TBI，总的癫痫发作率为0.7%（39/5551）。在总人群中，1795人被诊断为重度TBI（头部AIS评分3-5）。重度TBI组癫痫发作的可能性是非重度组的25倍[2.0%（36/1795）vs. 0.08%（3/3756）; OR 25.6; 95%CI 7.8-83.2; p < 0.0001]。在严重TBI后癫痫发作的患者中，25%（9/36）接受左乙拉西坦、苯妥英或磷苯妥英药物预防。在一个匹配的队列的倾向评分，左乙拉西坦组和无预防组（1.9与3.4%，p = 0.50）之间的癫痫发作率没有差异。ConclusionsIn this propensity score matched cohort analysis，左乙拉西坦预防是无效的，在预防癫痫发作的癫痫发作率是相似的，无论患者是否接受药物。在本研究中，严重TBI患者的创伤后癫痫发作发生率仅为2.0%;因此，我们质疑TBI患者常规预防性抗惊厥治疗的益处。
Introduction Early seizures after severe traumatic brain injury (TBI) have a reported incidence of up to 15 %. Prophylaxis for early seizures using 1 week of phenytoin is considered standard of care for seizure prevention. However, many centers have substituted the anticonvulsant levetiracetam without good data on the efficacy of this approach. Our hypothesis was that the treatment with levetiracetam is not effective in preventing early post-traumatic seizures.MethodsAll trauma patients sustaining a TBI from January 2007 to December 2009 at an urban level-one trauma center were retrospectively analyzed. Seizures were identified from a prospectively gathered morbidity database and anticonvulsant use from the pharmacy database. Statistical comparisons were made by Chi square, t tests, and logistic regression modeling. Patients who received levetiracetam prophylaxis were matched 1:1 using propensity score matching with those who did not receive the drug.Results5551 trauma patients suffered a TBI during the study period, with an overall seizure rate of 0.7 % (39/5551). Of the total population, 1795 were diagnosed with severe TBI (Head AIS score 3–5). Seizures were 25 times more likely in the severe TBI group than in the non-severe group [2.0 % (36/1795) vs. 0.08 % (3/3756); OR 25.6; 95 % CI 7.8–83.2; p < 0.0001]. Of the patients who had seizures after severe TBI, 25 % (9/36) received pharmacologic prophylaxis with levetiracetam, phenytoin, or fosphenytoin. In a matched cohort by propensity scores, no difference was seen in seizure rates between the levetiracetam group and no-prophylaxis group (1.9 vs. 3.4 %, p = 0.50).ConclusionsIn this propensity score-matched cohort analysis, levetiracetam prophylaxis was ineffective in preventing seizures as the rate of seizures was similar whether patients did or did not receive the drug. The incidence of post-traumatic seizures in severe TBI patients was only 2.0 % in this study; therefore we question the benefit of routine prophylactic anticonvulsant therapy in patients with TBI.
影响因子：
4.1
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
通讯作者：
Okonkwo DO
影响因子：
158.5
作者：
TEMKIN, NR;DIKMEN, SS;WINN, HR
通讯作者：
WINN, HR
影响因子：
4.1
作者：
Haltiner, AM;Newell, DW;Winn, HR
通讯作者：
Winn, HR