Randomized study of intravenous valproate and phenytoin in status epilepticus
Randomized study of intravenous valproate and phenytoin in status epilepticus
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DOI：
10.1016/j.seizure.2007.04.012
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发表时间：
2007-09-01
影响因子：
3
通讯作者：
Garg, Niren
中科院分区：
文献类型：
--
作者：
Agarwal, Puneet;Kumar, Navneet;Garg, Niren
引言：仍然缺乏指导苯二氮卓类难治性癫痫持续状态（SE）患者治疗的循证数据。我们进行了一项随机研究，以评估静脉注射（IV）苯妥英钠和静脉注射丙戊酸盐（IV VA）在苯二氮卓类药物难治性SE患者的比较效果。背景和方法：百名，年龄和性别匹配，苯二氮卓类药物难治性SE患者随机分为A组（50例），治疗IV VA和组B（50例）治疗IV苯妥英钠。12例SE不能用单一药物控制的患者被转到另一组。当所有运动或EEG癫痫发作活动在药物输注开始后20分钟内停止，并且在接下来的12小时内癫痫发作活动没有恢复时，认为治疗成功。次要研究终点为治疗不良事件、院内并发症和出院时神经学结局。结果：在本研究中，SE患者中，IV VA成功率为88%，IV苯妥英钠成功率为84%（p > 0.05），SE < 2 h患者的反应明显更好（p < 0.05）。两组不良事件总数无显著差异（p > 0.05）。有没有治疗之间的差异，复发后12小时的研究期间或在7 days.Conclusion的结果：IV VA是有效的IV苯妥英。它易于使用，耐受性更好，可作为苯二氮卓类难治性SE患者（尤其是心肺疾病患者）IV苯妥英的替代药物。SE持续时间较短（< 2 h）的患者结局较好，提示需要立即治疗。(c)2007年英国癫痫协会。由爱思唯尔有限公司出版。保留所有权利。
Introduction: The evidence based data to guide management in patients of benzodiazepine refractory status epilepticus (SE) is stilt lacking. We conducted a randomized study to evaluate the comparative effect of intravenous (IV) phenytoin and intravenous valproate (IV VA) in patients of benzodiazepine refractory SE.Background and methods: Hundred, age and sex matched, patients of benzodiazepine refractory SE were randomly divided into Group A (50 patients), treated with IV VA and Group B (50 patients) treated with IV phenytoin. Twelve patients, in whom SE was not controlled with a single drug, were switched over to the other group. Treatment was considered successful when all motor or EEG seizure activity ceased within 20 min after the beginning of the drug infusion and no return of seizure activity during the next 12 h. Secondary study end points were adverse events to treatment, in-hospital complications and the neurological outcome at discharge.Results: In this study, IV VA was successful in 88% and IV phenytoin in 84% (p > 0.05) of patients of SE with a significantly better response in patients of SE < 2 h (p < 0.05). The total number of adverse events did not differ significantly between the two groups (p > 0.05). There were no differences among the treatments with respect to recurrence after 12-h study period or the outcome at 7 days.Conclusion: IV VA is as effective as IV phenytoin. It is easy to use, better tolerated and can be used as an alternative to IV phenytoin in patients of benzodiazepine refractory SE, especially in patients of cardio-respiratory disease. The better outcome in patients having shorter duration of SE (< 2 h) suggests need of immediate treatment. (c) 2007 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.