Intervention Review

Anticonvulsant therapy for status epilepticus

  1. Kameshwar Prasad1,*,
  2. Khaldoon Al-Roomi2,
  3. Pudukode R Krishnan3,
  4. Reginald Sequeira4

Editorial Group: Cochrane Epilepsy Group

Published Online: 19 OCT 2005

Assessed as up-to-date: 14 JUL 2005

DOI: 10.1002/14651858.CD003723.pub2

How to Cite

Prasad K, Al-Roomi K, Krishnan PR, Sequeira R. Anticonvulsant therapy for status epilepticus. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD003723. DOI: 10.1002/14651858.CD003723.pub2.

Author Information

  1. 1

    All India Institute of Medical Sciences, Department of Neurology, New Delhi, India

  2. 2

    The Arabian Gulf University, Department of Family and Community Medicine, Manama, Bahrain

  3. 3

    Salmaniya Medical Complex, Clinical Neurosciences, Manama 311, Bahrain

  4. 4

    The Arabian Gulf University, Department of Pharmacology and Therapeutics, Manama, Bahrain

*Kameshwar Prasad, Department of Neurology, All India Institute of Medical Sciences, Ansarinagar, New Delhi, 110029, India. drkameshwarprasad@yahoo.co.in.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 OCT 2005

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Status epilepticus is a medical emergency associated with significant mortality and morbidity, which requires immediate and effective treatment.

Objectives

(1) To determine whether a particular anticonvulsant is more effective or safer to use in status epilepticus compared to another and compared to placebo.
(2) To delineate reasons for disagreement in the literature regarding recommended treatment regimens and to highlight areas for future research.

Search methods

We searched the following electronic databases using the highly sensitive search strategy for identifying published randomised controlled trials: (1) Cochrane Epilepsy Group Specialized Register (July 2005); (2) Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2,2005); (3) MEDLINE (1966 - August 2004); (4) EMBASE (1966 - January 2003).

Selection criteria

Randomised controlled trials of participants with premonitory, early, established or refractory status epilepticus using a truly random or quasi-random allocation of treatments were included.

Data collection and analysis

Two review authors independently selected trials for inclusion, assessed trial quality and extracted data.

Main results

Eleven studies with 2017 participants were included. Few studies used the same interventions. Diazepam was better than placebo in reducing the risk of non-cessation of seizures (RR 0.73, 95% CI 0.57 to 0.92), requirement for ventilatory support (RR 0.39, 95% CI 0.16 to 0.94) or continuation of status epilepticus requiring use of a different drug or general anaesthesia (RR 0.73, 95% CI 0.57 to 0.92). Lorazepam was better than placebo for risk of non-cessation of seizures (RR 0.52, 95% CI 0.38 to 0.71) and for risk of continuation of status epilepticus requiring a different drug or general anaesthesia (RR 0.52, 95% CI 0.38 to 0.71). Lorazepam was better than diazepam for reducing risk of non-cessation of seizures (RR 0.64, 95% CI 0.45 to 0.90) and had a lower risk for continuation of status epilepticus requiring a different drug or general anaesthesia (RR 0.63, 95% CI 0.45 to 0.88). Lorazepam was better than phenytoin for risk of non-cessation of seizures (RR 0.62, 95% CI 0.45 to 0.86). Diazepam (30 mg intrarectal gel) was better than a lower dose (20 mg intrarectal gel) in premonitory status epilepticus for the risk of seizure continuation (RR 0.39, 95% CI 0.18 to 0.86).

Authors' conclusions

Lorazepam is better than diazepam or phenytoin alone for cessation of seizures and carries a lower risk of continuation of status epilepticus requiring a different drug or general anaesthesia. Both lorazepam and diazepam are better than placebo for the same outcomes. In the treatment of premonitory seizures, diazepam 30 mg in an intrarectal gel is better than 20 mg for cessation of seizures without a statistically significant increase in adverse effects. Universally accepted definitions of premonitory, early, established and refractory status epilepticus are required.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Anticonvulsant therapy for status epilepticus

Lorazepam is better than diazepam or phenytoin for immediate control of status epilepticus.

Status epilepticus is a medical emergency in which there is either more than 30 minutes of continuous seizure activity; or there are two or more sequential seizures without recovery of full consciousness between two seizures. Many drugs have been studied in the management of this condition. The review found that lorazepam is better than diazepam or phenytoin for immediate control of status epilepticus. In the treatment of serially occurring seizures, diazepam gel administered rectally is effective in controlling seizures. There is a need to conduct more studies on other drugs routinely used for this condition.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

對重積性癲癇的抗癲癇治療藥物

重積性癲癇為內科急症,會造成死亡及後遺症,需要立刻及有效的治療。

目標

1.是否使用某特定抗癲癇藥物,相較於其它藥物或安慰劑,更為有效或安全。 2.釐清文獻中的建議用藥之間為何會有不一致的理由,並強調未來研究的領域。

搜尋策略

我們在以下的電子資料庫中用高敏感性的搜尋策略來找出已發表的隨機控制試驗:(1) Cochrane Epilepsy Group Specialized Register (July 2005); (2) Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2,2005); (3) MEDLINE (1966 – August 2004); (4) EMBASE (1966 – January 2003).

選擇標準

針對先兆性、早期、正在發生、或頑固性的重積性癲癇發作的病人,使用真隨機或類隨機分配治療方式之隨機分配控制試驗。

資料收集與分析

兩位評論者獨立的篩選引用的臨床試驗,評估試驗的品質以及摘錄資料。

主要結論

共11個研究2,017個參與者被選入,其中有少數研究使用相同的治療方式。Diazepam在減少「非停止性的癲癇(相對危險0.73,95%信賴區間0.57 to 0.92)」、「需要使用呼吸器(相對危險0.39,95%信賴區間0.16 to 0.94)」或「持續重積性癲癇,需第二種藥物或全身麻醉(相對危險0.73,95%信賴區間0.57 to 0.92)」這三種情況表現優於安慰組。Lorazepam在減少「非停止性的癲癇(相對危險0.52,95%信賴區間0.38 to 0.71)」或「持續重積性癲癇,需第二種藥物或全身麻醉(相對危險0.52,95%信賴區間0.38 to 0.71)」表現優於安慰組。Lorazepam在減少「非停止性的癲癇(相對危險0.64,95%信賴區間0.45 to 0.90))及或「持續重積性癲癇,需第二種藥物或全身麻醉(相對危險0.63,95%信賴區間0.45 to 0.88)」這兩種危險上優於Diazepam。Lorazepam在減少「非停止性的癲癇(相對危險0.62,95%信賴區間0.45 to 0.86)」的危險上優於Phenytoin。對於先兆性重積癲癇發作的病人,Diazepam 凝膠30 mg經直腸給藥比低劑量20mg,更能減少繼續癲癇的風險(相對危險0.39,95%信賴區間0.18 to 0.86)。

作者結論

在癲癇的終止或需其他種藥物或全身麻醉以降低持續癲癇的風險上,使用Lorazepam比Diazepam或Phenytoin要好。不論Lorazepam或Diazepam在三種預後指標上,都比安慰劑要好。對於先兆性癲癇,Diazepam凝膠30mg經直腸給藥比20mg在終止癲癇上有較好的效果,且沒有顯著增加副作用。但目前對先兆性、早期、發作中、或頑固性癲癇尚缺乏全球一致性的定義。

翻譯人

本摘要由臺北榮民總醫院程國維翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

Lorazepam比Diazepam或Phenytoin在重積性癲癇發作時的立即控制上較有效。重積性癲癇發作是一種內科急症,定義為超過30分鐘的癲癇發作或2個或以上的連續癲癇發作間意識沒有完全恢復者。有許多藥物針對此症的治療做研究。本篇回顧文章發現 Lorazepam比Diazepam或Phenytoin在重積性癲癇發作時的立即控制上較有效。對於一連串發生的癲癇,Diazepam凝膠經直腸給藥在終止癲癇上有較好的效果。對於此種情況下其他例行藥物的給予,還需要更多的研究。