Overview of studies to prevent posttraumatic epilepsy
Overview of studies to prevent posttraumatic epilepsy
复制标题
DOI：
10.1046/j.1528-1157.44.s10.1.x
复制
发表时间：
2003-01-01
期刊：
影响因子：
5.6
通讯作者：
Beghi, E
中科院分区：
文献类型：
--
作者：
Beghi, E
目的：预防创伤性癫痫(PTE)对降低创伤性脑损伤(TBI)后功能障碍程度具有重要意义。然而，对于脑外伤患者，抗癫痫药物的疗效必须分别从预防和控制诱发性癫痫发作(包括即刻和早期创伤后癫痫发作)和预防随后的无缘性癫痫发作(晚期创伤后癫痫发作或PTE)两个方面进行评估。方法：通过评估潜在的致痫机制、文献报道和系统综述，确定减少或预防脑外伤后癫痫发展的策略和结果。结果：在观察性研究中，接受治疗的患者发生癫痫发作的比例为0-10%，而未治疗的患者发生癫痫发作的比例为2%-50%。在随机临床试验中，积极治疗[苯妥英钠(PHT)、苯巴比妥或卡马西平(CBZ)]和安慰剂之间的差异在随访3到60个月后没有那么显著，而且几乎没有预防PTE的作用。在Cochrane对来自10个评估PHT或CBZ的随机对照试验的890名患者进行的系统评估中，预防早期癫痫发作的汇集相对风险(RR)为0.33(95%CI 0.21-0.52)。而预防迟发性癫痫发作的相对危险度为1.28(95%CI为0.90~1.81)。两个治疗组的死亡率和神经功能障碍相似。使用PHT之后，皮疹的风险增加(不显著)。此外，在严重创伤患者中，PHT在1个月时显著影响认知功能，在停止治疗后认知功能得到改善。结论：在脑外伤患者的研究中，未能影响PTE风险的研究结果类似于其他条件下预防癫痫的随机临床试验的荟萃分析结果，如热性癫痫、脑疟疾、开颅手术和过量饮酒。出于这些原因，抗癫痫药物的预防性使用应该是短期的，并仅限于防止立即和早期癫痫发作。只有在诊断为PTE后才应考虑慢性治疗。
Purpose: Prevention of posttraumatic epilepsy (PTE) is of primary importance to reduce the degree of functional morbidity following traumatic brain injury (TBI). However, the effects of antiepileptic drugs (AEDs) in patients with TBI must be assessed separately in terms of prevention and control of provoked seizures (which include immediate and early posttraumatic seizures) and prevention of subsequent unprovoked seizures (late posttraumatic seizures or PTE).Methods: Potential mechanisms for prevention of epileptogenesis as well as reports and systematic reviews were evaluated to determine strategies and results of attempts to reduce or prevent the development of epilepsy following TBI.Results: In observational studies, after a period ranging from 6 months to 13 years, the proportion of cases developing seizures was 0-10% in patients receiving treatment compared to 2-50% in those who were left untreated. In randomized clinical trials, the difference between active treatment [phenytoin (PHT), phenobarbital, or carbamazepine (CBZ)} and placebo was less remarkable after a follow-up ranging from 3 to 60 months and was virtually lacking for the prevention of PTE. In a Cochrane systematic review of 890 patients from 10 RCTs assessing PHT or CBZ, the pooled relative risk (RR) for prevention of early seizures was 0.33 (95% Cl 0.21-0.52). By contrast, the RR for prevention of late seizures was 1.28 (95% Cl 0.90-1.81). Mortality and neurological disability were similar in the two treatment groups. The use of PHT was followed by an increased (nonsignificant) risk of skin rashes. In addition, cognitive performance was significantly affected by PHT in severely injured patients at 1 month and treatment withdrawal was followed by improvement in cognitive function.Conclusions: The failure to influence the risk of PTE in studies of patients with TBI are similar to findings of meta-analysis of randomized clinical trials on seizure prevention in other conditions, such as febrile seizures, cerebral malaria, craniotomy, and excessive alcohol intake. For these reasons, the prophylactic use of AEDs should be short-lasting and limited to the prevention of immediate and early seizures. Chronic treatment should be considered only after a diagnosis of PTE.