Practice parameter: Antiepileptic drug prophylaxis in severe traumatic brain injury - Report of the Quality Standards Subcommittee of the American Academy of Neurology
Practice parameter: Antiepileptic drug prophylaxis in severe traumatic brain injury - Report of the Quality Standards Subcommittee of the American Academy of Neurology
复制标题
DOI：
10.1212/01.wnl.0000031432.05543.14
复制
发表时间：
2003-01-14
期刊：
影响因子：
9.9
通讯作者：
Lowenstein, DH
中科院分区：
文献类型：
--
作者：
Chang, BS;Lowenstein, DH
目的：目的：回顾抗癫痫药物（AED）预防重型创伤性脑损伤（TBI）患者癫痫发作的证据，并提出实践建议。方法：作者通过搜索多个数据库和审查其他来源的参考文献列表来识别相关研究。他们包括前瞻性比较接受AED预防与对照的患者创伤后癫痫发作率的研究。根据标准证据分类方案对每项研究进行分级（I类至IV类），并对结果进行分析和汇总。结果如下：合并I类研究表明，与对照组相比，接受苯妥英预防治疗的患者发生早期创伤后癫痫发作（在损伤后7天内发生）的风险显著降低（相对风险0.37，95% CI 0.18至0.74）。合并的I类和II类研究表明，与对照组相比，接受AED预防治疗的患者的迟发性创伤后癫痫发作（发生在损伤后7天以上）风险无显著差异（相对风险1.05，95% CI 0.82至1.35）。在这些研究中，血清AED水平不理想，不良反应轻微但频繁。结论：对于成人严重TBI患者，苯妥英钠预防性治疗可有效降低创伤后早期癫痫发作的风险。AED预防可能不能有效地降低创伤后迟发性癫痫发作的风险。建议进一步研究轻度TBI、新型AEDs的使用、EEG的效用以及这些发现对儿童的适用性。
Objective: To review the evidence regarding antiepileptic drug (AED) prophylaxis in patients with severe traumatic brain injury (TBI) in order to make practice recommendations. Methods: The authors identified relevant studies by searching multiple databases and reviewing reference lists of other sources. They included studies that prospectively compared post-traumatic seizure rates in patients given AED prophylaxis vs controls. Each study was graded (class I to IV) according to a standard classification-of-evidence scheme and results were analyzed and pooled. Results: Pooled class I studies demonstrated a significantly lower risk of early post-traumatic seizures (those occurring within 7 days after injury) in patients given phenytoin prophylaxis compared to controls (relative risk 0.37, 95% CI 0.18 to 0.74). Pooled class I and class II studies demonstrated no significant difference in the risk of late post-traumatic seizures (those occurring beyond 7 days after injury) in patients given AED prophylaxis compared to controls (relative risk 1.05, 95% CI 0.82 to 1.35). Serum AED levels were suboptimal in these studies and adverse effects were mild but frequent. Conclusions: For adult patients with severe TBI, prophylaxis with phenytoin is effective in decreasing the risk of early post-traumatic seizures. AED prophylaxis is probably not effective in decreasing the risk of late post-traumatic seizures. Further studies addressing milder forms of TBI, the use of newer AEDs, the utility of EEG, and the applicability of these findings to children are recommended.