Comparison of Short-Duration Levetiracetam with Extended-Course Phenytoin for Seizure Prophylaxis After Subarachnoid Hemorrhage
Comparison of Short-Duration Levetiracetam with Extended-Course Phenytoin for Seizure Prophylaxis After Subarachnoid Hemorrhage
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DOI：
10.1016/j.wneu.2010.09.002
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发表时间：
2011-02-01
影响因子：
2
通讯作者：
Dhar, Rajat
中科院分区：
文献类型：
--
作者：
Murphy-Human, Theresa;Welch, Emily;Dhar, Rajat
背景：蛛网膜下腔出血（SAH）后预防癫痫发作的最佳方案仍不确定。基于表明短期疗程可能就足够的数据，再加上苯妥英暴露与不良认知结果之间的关联，我们的机构修改了 SAH 患者的癫痫发作预防方案，从苯妥英延长疗程改为 3 天左乙拉西坦。本研究旨在比较这一改变前后癫痫发作的发生率，以评估短期左乙拉西坦疗程是否能有效预防院内癫痫发作。 方法：本研究分析了 2003 年 1 月至 2008 年 1 月期间连续入院的 442 名 SAH 患者，其中包括 297 名在方案变更前接受治疗的患者（PHT 组）和 145 名在方案变更后接受治疗的患者（LEV 组）。所有癫痫发作的发生都是从前瞻性收集的重症监护病房数据库中提取的，并进一步审查了医疗记录。院内癫痫发作分为早期（发生在第 3 天或之前，所有患者均接受预防）和晚期（第 3 天后，LEV 组停止预防）。 结果：院内癫痫发作发生率在 PHT 组中为 3.4%，在 LEV 组中为 8.3%（P = 0.03）。尽管早期癫痫发作率没有差异（1.4% PHT vs. 2.8% LEV，P = 0.45），但晚期癫痫发作率较高（2% PHT vs. 5.5% LEV，P = 0.05）。结论：与延长疗程相比，SAH 后使用短疗程左乙拉西坦预防癫痫发作与院内癫痫发作率较高相关。苯妥英，主要与停用左乙拉西坦后晚期癫痫发作增加有关。这表明，尽管需要进行验证性研究，但可能需要更长的预防时间才能最大程度地减少 SAH 患者的癫痫发作。
BACKGROUND: The optimal regimen for seizure prophylaxis after subarachnoid hemorrhage (SAH) remains uncertain. Based on data suggesting that a short course may be adequate, coupled with an association between phenytoin exposure and poor cognitive outcome, our institution modified their seizure prophylaxis protocol for patients with SAH from an extended course of phenytoin to 3 days of levetiracetam. This study sought to compare the incidence of seizures before and after this change to evaluate whether a short course of levetiracetam would be as effective in preventing in-hospital seizures.METHODS: This study analyzed 442 consecutive patients admitted with SAH between January 2003 and January 2008, including 297 patients treated before the protocol change (PHT group) and 145 treated afterward (LEV group). Occurrence of all seizures was extracted from a prospectively collected intensive care unit database and further review of medical records. In-hospital seizures were divided into early (occurring on or before day 3, all patients on prophylaxis) and those occurring late (after day 3, LEV group off prophylaxis).RESULTS: In-hospital seizures occurred in 3.4% of the PHT group and 8.3% of the LEV group (P = 0.03). Although the rate of early seizures was not different (1.4% PHT vs. 2.8% LEV, P = 0.45), there was a higher rate of late seizures (2% PHT vs. 5.5% LEV, P = 0.05).CONCLUSIONS: The use of short-duration levetiracetam for seizure prophylaxis after SAH was associated with a higher rate of in-hospital seizures than an extended course of phenytoin, mainly related to an increase in late seizures, when the levetiracetam had been discontinued. This suggests that a longer duration of prophylaxis may be required to minimize seizures in patients with SAH, although confirmatory studies are required.