Second-line status epilepticus treatment: Comparison of phenytoin, valproate, and levetiracetam
Second-line status epilepticus treatment: Comparison of phenytoin, valproate, and levetiracetam
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DOI：
10.1111/j.1528-1167.2011.03056.x
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发表时间：
2011-07-01
期刊：
影响因子：
5.6
通讯作者：
Rossetti, Andrea O.
中科院分区：
文献类型：
--
作者：
Alvarez, Vincent;Januel, Jean-Marie;Rossetti, Andrea O.
目的：苯妥英钠（PHT），丙戊酸（VPA），或左乙拉西坦（LEV）是常用的癫痫持续状态（SE）的二线治疗，但比较研究是不可用的。方法：在279成人SE事件前瞻性地确定在我们的三级保健医院超过4年，我们回顾性地确定了187次发作中，PHT，丙戊酸，或LEV后给予苯二氮卓类药物。缺氧后SE患者不包括在内。评估了人口统计学、临床SE特征、二线治疗控制SE失败、新发残疾和出院时死亡率。单变量和多变量的统计分析被应用到比较三个agents.Key Findings：每种化合物被用于约三分之一的SE发作。VPA未能控制25.4%的SE，41.4%的PHT和48.3%的LEV。VPA组的致命病因更常见，而PHT组的SE发作往往更严重。校正这些已知SE结局预测因素后，LEV失败的频率高于VPA [比值比（OR）2.69; 95%置信区间（CI）1.19-6.08]; 16.8%（95% CI：6.0-31.4%）的二线治疗失败可归因于LEV。PHT与其他两种化合物无统计学差异。二线治疗似乎没有影响新的障碍和死亡率，而病因和SE严重程度评分（STESS）是强大的独立predictor.Significance：即使没有显着差异的结果在出院时，LEV似乎不如VPA有效控制SE后苯二氮卓类药物。需要一项前瞻性比较试验来解决这一潜在的相关发现。
Purpose: Phenytoin (PHT), valproic acid (VPA), or levetiracetam (LEV) are commonly used as second-line treatment of status epilepticus (SE), but comparative studies are not available.Methods: Among 279 adult SE episodes identified prospectively in our tertiary care hospital over 4 years, we retrospectively identified 187 episodes in which PHT, VPA, or LEV were given after benzodiazepines. Patients with postanoxic SE were not included. Demographics, clinical SE features, failure of second-line treatment to control SE, new handicap, and mortality at hospital discharge were assessed. Uni- and multivariable statistical analyses were applied to compare the three agents.Key Findings: Each compound was used in about one third of SE episodes. VPA failed to control SE in 25.4%, PHT in 41.4%, and LEV in 48.3% of episodes in which these were prescribed. A deadly etiology was more frequent in the VPA group, whereas SE episodes tended to be more severe in the PHT group. After adjustment for these known SE outcome predictors, LEV failed more often than VPA [odds ratio (OR) 2.69; 95% confidence interval (CI) 1.19-6.08]; 16.8% (95% CI: 6.0-31.4%) of second-line treatment failures could be attributed to LEV. PHT was not statistically different from the other two compounds. Second-line treatment did not seem to influence new handicap and mortality, whereas etiology and the SE Severity Score (STESS) were robust independent predictors.Significance: Even without significant differences on outcome at discharge, LEV seems less efficient than VPA to control SE after benzodiazepines. A prospective comparative trial is needed to address this potentially concerning finding.