Treatment of pediatric epilepsy: European expert opinion, 2007.
Treatment of pediatric epilepsy: European expert opinion, 2007.
复制标题
DOI：
10.1684/epd.2007.0144
复制
发表时间：
2007-11
期刊：
影响因子：
--
通讯作者：
J. Wheless;Dave F. Clarke;A. Arzimanoglou;D. Carpenter
中科院分区：
文献类型：
--
作者：
J. Wheless;Dave F. Clarke;A. Arzimanoglou;D. Carpenter
儿童癫痫是一种异质性的疾病，在诊断标准和治疗方面存在差异，其结果也存在显著差异。尽管关于癫痫治疗的数据越来越多，但关于儿童癫痫的研究结果却比较有限，许多临床问题仍未得到解答，因此临床医生往往必须依靠临床判断。在这种临床情况下，专家意见可能特别有用。方法向57名欧洲儿科癫痫专科医生发送了一份关于儿童癫痫和发作的调查（33个问题和大约650种治疗方案），其中42名（74%）完成了调查。在一些问题中，专家被要求推荐针对特定综合征的总体治疗方法（他们使用某些策略的顺序）。大多数问题要求专家使用兰德9分制的修改版本对医疗适宜性进行评分。共识被定义为卡方检验分数的非随机分布，用评分来分配每个选项的分类等级（第一行/通常合适，第二行/模棱两可，第三行/通常不合适）。结果丙戊酸是治疗症状性肌阵挛和全身性强直阵挛发作的首选药物。对于复杂部分性癫痫的初始单药治疗，卡马西平和奥卡西平是首选治疗方法，丙戊酸也是一线治疗方法。作为结节性硬化症引起的婴儿痉挛的初始治疗，万艾加巴特林是首选的治疗方法。作为病因上有症状的婴儿痉挛的初始治疗，维加巴特林也是首选的治疗方法，促肾上腺皮质激素（ACTH）和强的松是其他一线治疗选择。作为lenox - gastaut综合征的初始治疗，丙戊酸是首选的治疗方法。对于长期发热性惊厥或丛集性惊厥的急性治疗，直肠安定是治疗的选择。丙戊酸是预防热性惊厥的首选治疗方法。对于良性儿童癫痫与中央颞峰，丙戊酸是治疗的选择。对于儿童和青少年缺席癫痫，丙戊酸是首选治疗药物，拉莫三嗪是另一种一线治疗方案（乙索昔胺是儿童缺席癫痫的另一种一线治疗方案）。对于青少年男性肌阵挛性癫痫，丙戊酸是首选治疗，拉莫三嗪是另一个一线治疗选择；对于青少年女性的青少年肌阵挛性癫痫，拉莫三嗪是治疗的选择，丙戊酸是另一个一线选择。作为新生儿癫痫持续状态的初始治疗，静脉注射（IV）苯巴比妥是治疗的选择。作为所有类型的儿童癫痫持续状态的初始治疗，静脉注射安定是首选的治疗方法。对于全身性强直-阵挛性癫痫持续状态，直肠安定和静脉劳拉西泮也是治疗的选择；对于复杂的部分癫痫持续状态，静脉注射劳拉西泮是另一个一线选择。结论专家小组对多种治疗方案达成共识。在专家意见的范围内，在认识到新的研究数据可能优先考虑的情况下，专家的建议在医学文献不足或缺乏的情况下提供了有益的指导。应结合基于证据的调查结果对本报告中的信息进行评估。
BACKGROUND Childhood epilepsies are a heterogeneous group of conditions that differ in diagnostic criteria and management and have dramatically different outcomes. Despite increasing data on treatment of epilepsy, research findings on childhood epilepsy are more limited and many clinical questions remain unanswered, so that clinicians must often rely on clinical judgment. In such clinical situations, expert opinion can be especially helpful. METHODS A survey on pediatric epilepsy and seizures (33 questions and approximately 650 treatment options) was sent to 57 European physicians specializing in pediatric epilepsy, 42 (74%) of whom completed it. In some questions, the experts were asked to recommend overall treatment approaches for specific syndromes (the order in which they would use certain strategies). Most of the questions asked the experts to rate options using a modified version of the RAND 9-point scale for medical appropriateness. Consensus was defined as a non-random distribution of scores by chi-square test, with ratings used to assign a categorical rank (first line/usually appropriate, second line/equivocal, and third line/usually not appropriate) to each option. RESULTS Valproate was treatment of choice for symptomatic myoclonic and generalized tonic-clonic seizures. For initial monotherapy for complex partial seizures, carbamazepine and oxcarbazepine were treatments of choice, with valproate also first line. As initial therapy for infantile spasms caused by tuberous sclerosis, viagabatrin was treatment of choice. As initial therapy for infantile spasms that are symptomatic in etiology, vigabatrin was also treatment of choice, with adrenocorticotropic hormone (ACTH) and prednisone other first-line options. As initial therapy for Lennox-Gastaut syndrome, valproate was treatment of choice. For acute treatment of a prolonged febrile seizure or cluster of seizures, rectal diazepam was treatment of choice. Valproate was treatment of choice as preventive therapy for febrile seizures. For benign childhood epilepsy with centro-temporal spikes, valproate was treatment of choice. For childhood and juvenile absence epilepsy, valproate was treatment of choice, with lamotrigine another first-line option (ethosuximide was another first-line option for childhood absence epilepsy). For juvenile myoclonic epilepsy in adolescent males, valproate was treatment of choice, with lamotrigine another first-line option; for juvenile myoclonic epilepsy in adolescent females, lamotrigine was treatment of choice, with valproate another firstline option. As initial therapy for neonatal status epilepticus, intravenous (IV) phenobarbital was treatment of choice. As initial therapy for all types of pediatric status epilepticus, IV diazepam was treatment of choice. For generalized tonic-clonic status epilepticus, rectal diazepam and IV lorazepam were also treatments of choice; for complex partial status epilepticus, IV lorazepam was another first-line option. CONCLUSION The expert panel reached consensus on many treatment options. Within the limits of expert opinion and with the understanding that new research data may take precedence, the experts' recommendations provide helpful guidance in situations where the medical literature is scant or lacking. The information in this report should be evaluated in conjunction with evidence-based findings.