Neurobehavioral effects of phenytoin prophylaxis of posttraumatic seizures.
Neurobehavioral effects of phenytoin prophylaxis of posttraumatic seizures.
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DOI：
10.1001/jama.1991.03460100073027
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发表时间：
1991-03
期刊：
影响因子：
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通讯作者：
S. Dikmen;N. Temkin;Bonnie Miller;J. Machamer;H. Winn
中科院分区：
文献类型：
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作者：
S. Dikmen;N. Temkin;Bonnie Miller;J. Machamer;H. Winn
为了确定苯妥英钠预防创伤后癫痫发作的潜在负面神经行为效应，244例受试者被随机分配至苯妥英钠组或安慰剂组。他们在受伤后1个月和12个月接受了神经行为评估，同时接受了指定的药物，并在24个月时没有接受药物。在严重受伤，苯妥英显着损害性能在1个月。在中度损伤患者1个月或严重程度组1年时，苯妥英钠的作用无显著差异。根据方案停止接受苯妥英钠治疗1 - 2年的患者在几项指标上的改善程度高于相应的安慰剂组。我们得出结论，苯妥英钠有负面的认知影响。这一点，加上缺乏证据表明其在预防创伤后癫痫发作超过第一周的有效性，提出了关于其用于长期预防的问题。我们的研究结果并不否定苯妥英钠在控制癫痫发作方面的有效性，也不表明其对认知的影响比其他抗癫痫药物更差。
In order to determine potential negative neurobehavioral effects of phenytoin given to prevent the development of posttraumatic seizures, 244 subjects were randomized to phenytoin or placebo. They received neurobehavioral assessments at 1 and 12 months postinjury while receiving their assigned drug and at 24 months while receiving no drugs. In the severely injured, phenytoin significantly impaired performance at 1 month. No significant differences were found as a function of phenytoin in the moderately injured patients at 1 month or in either severity group at 1 year. Patients who stopped receiving phenytoin according to protocol between 1 and 2 years improved more than corresponding placebo cases on several measures. We conclude that phenytoin has negative cognitive effects. This, combined with lack of evidence for its effectiveness in preventing posttraumatic seizures beyond the first week, raises questions regarding its use for long-term prophylaxis. Our findings do not negate phenytoin's proven efficacy in controlling established seizures nor do they indicate that its cognitive effects are worse than other anticonvulsant drugs.