Recent antiseizure medications in the Intensive Care Unit.
Recent antiseizure medications in the Intensive Care Unit.
复制标题
重症监护病房最近使用的抗癫痫药物。
作者：
Cindy Orinx;B. Legros;N. Gaspard
背景
临床和亚临床的癫痫发作和癫痫持续状态 (SE) 在危重患者中很常见。可用的抗癫痫药物 (ASM) 列表正在不断扩大，现在包括较旧且广泛使用的药物以及具有更好安全性和药代动力学特征的较新药物。
方法
我们回顾了最近关于 ASM 在重症监护中预防和治疗癫痫和 SE 的适应症和给药的精选出版物，重点关注最近可用作静脉制剂的 ASM，并强调与危重疾病的几个方面相关的药代动力学和安全问题。
结果
左乙拉西坦、拉科酰胺和最近的布瓦西坦代表了较旧的 ASM 的有趣替代品，主要是因为其更有利的安全性和药代动力学特征。低质量的研究表明，这种情况可以使接受治疗的患者具有更好的耐受性。由于其不同的作用机制和心血管特性，氯胺酮可能是我们治疗难治性 SE 的麻醉装备中的一种有用补充。然而，除了特定情况（创伤性脑损伤和蛛网膜下腔出血）之外，几乎没有证据支持危重患者预防性使用 ASM。比较最近和较早的 ASM 在治疗急性癫痫和 SE 方面的头对头研究正在进行或正在等待发表。重症患者使用 ASM 需要适应器官功能障碍，尤其是近期药物的肾功能障碍。
结论
最近的 ASM 可能代表重症患者比老年患者更好的治疗选择，但这需要在随机对照研究中得到证实。一般来说，需要进一步研究来阐明 ASM 在重症监护环境中的适应症和最佳使用。
BACKGROUND
Seizures and status epilepticus (SE), both clinical and subclinical, are frequent in critically ill patients. The list of available antiseizure medications (ASMs) is expanding and now includes older and widely used drugs as well as more recent medications with a better safety and pharmacokinetics profile.
METHODS
We review a selection of recent publications about the indications and administration of ASMs in critical care for the prophylaxis and treatment of seizures and SE, focusing on recent ASMs available as intravenous formulation and emphasizing pharmacokinetics and safety issues in relation to several aspects of critical illness.
RESULTS
Levetiracetam, lacosamide and more recently brivaracetam, represent interesting alternatives to older ASMs, mostly due to a more favorable safety and pharmacokinetic profile. Low-quality studies suggest that this profile results in better tolerability in treated patients. Ketamine might represent a useful addition in our anesthetic armamentarium for refractory SE, due to its different mechanism of action and cardiovascular properties. Little evidence is available however to support the prophylactic use of ASMs in critically ill patients, except in specific settings (traumatic brain injury and subarachnoid hemorrhage). Head-to-head studies comparing recent and older ASMs in the treatment of acute seizures and SE are ongoing or awaiting publication. Administration of ASMs to critically ill patients needs to be adapted to organ dysfunction, and especially to renal dysfunction for recent drugs.
CONCLUSIONS
Recent ASMs and could represent better treatment choices in critically ill patients than older ones but this needs to be confirmed in randomized controlled studies. In general, further studies are required to clarify the indications and optimal use of ASMs in the critical care setting.