Anticonvulsants for preventing seizures in patients with chronic subdural haematoma

 

Abstract

Background

Anticonvulsant therapy is sometimes used prophylactically in patients with chronic subdural haematoma, although the benefit is unclear.

Objectives

To establish the effectiveness of prophylactic anticonvulsants in patients with chronic subdural haematoma, for both pre- and post-operative periods.

Search methods

We searched the Cochrane Injuries Group's Specialised Register, CENTRAL (The Cochrane Library, Issue 1, 2009), MEDLINE, EMBASE, LILACS, the American Association of Neurological Surgeons (AANS) Database and the conference proceedings of the European Association of Neurosurgical Societies (EANS). We also searched the reference lists of all relevant studies.

Selection criteria

Randomised controlled trials comparing any anticonvulsant versus placebo or no intervention.

Data collection and analysis

No trials met the inclusion criteria for the review.

Main results

No randomised, controlled trials were identified.

Authors' conclusions

No formal recommendations can be made about the use of prophylactic anticonvulsants in patients with chronic subdural haematoma based on the literature currently available. Non-controlled studies came up with conflicting results. There is an urgent need for well-designed randomised controlled trials.

 

Plain language summary

Anti-epileptic drugs for preventing seizures in patients with long-term subdural haematoma

Chronic subdural haematoma (CSH) is a serious condition in which blood collects under the thickest membrane that surrounds the brain, known as the dura mater. CSH is usually caused by minor head injuries in which a vein has torn, and this happens in particular in older patients and patients with other brain problems. A CSH may cause seizures which can be dangerous. Some doctors give patients anti-epileptic drugs such as phenytoin or phenobarbital to try to prevent seizures. However, most patients with CSH will not have seizures and anti-epileptic drugs can have serious side effects.

The review authors researched whether patients with a CSH who received anti-epileptic drugs had fewer seizures than those who did not. They searched the medical journal literature to find randomised controlled trials in which one group of patients received a treatment (anti-epileptic drugs, which could be given before or after surgery for the CSH) and was compared with a similar group which received a non-active or different treatment. The authors could find no randomised controlled trials. They did find other studies which were not as high quality evidence. These had conflicting results regarding the benefit of anti-epileptics.

The review authors conclude that better research needs to be done on this topic and, for now, there is no clear evidence to support the regular use of anti-epileptic drugs for patients with long-term subdural haematoma.

 

摘要

背景

抗癲癇藥用於預防慢性硬膜下血腫病患的癲癇發作

抗癲癇藥物治療有時被預防使用於慢性硬膜下血腫，但目前對於其好處仍不清楚。

目標

建立預防性抗癲癇藥物使用於慢性硬膜下血腫病患，於手術前和後的有效性。

搜尋策略

我們搜尋了，Cochrane Injuries Group Specialised Register, Cochrane Controlled Trials Register, MEDLINE, EMBASE, LILACS，美國神經外科醫師協會的資料庫和歐洲協會神經外科學會之會議程序的摘要書籍。我們還搜查了所有確定研究的參考資料。

選擇標準

隨機對照試驗比較任何抗癲癇藥物與安慰劑或沒有任何介入。

資料收集與分析

沒有任何試驗符合納入此回顧的標準。

主要結論

沒有隨機對照試驗被確認。

作者結論

沒有正式的建議有關，使用預防性抗癲癇藥物對於慢性硬膜下血腫病患，基於現有可使用的文獻。非對照性的研究提出了相互矛盾的結果。目前迫切需要設計良好的隨機對照試驗。

翻譯人

本摘要由高雄榮民總醫院洪碧蓮翻譯。

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

總結

抗癲癇藥物用以預防長期硬膜下血腫患者的癲癇發作。慢性的硬膜下血腫是一種嚴重的情況即血液收集在最厚的膜下，這層膜包裹大腦，被稱為硬腦膜。硬膜下血腫通常是由於輕微的頭部受傷，其中靜脈撕裂，尤其是老人或有其他腦部問題的病人所引起。硬膜下血腫可能會導致癲癇發作是嚴重的。一些醫生開給病人抗癲癇藥物如苯妥英鈉或苯巴比妥，設法防止癲癇發作。但是，大多數硬膜下血腫的患者沒有發生癲癇但服用抗癲癇藥物產生嚴重的副作用。作者研究是否硬膜下血腫的患者服用抗癲癇藥物產生癲癇的發作比沒服用的較少。抗癲癇藥物可考慮在手術治療前或之後給予硬膜下血腫的患者。他們搜查了醫學期刊文獻找到隨機對照試驗，其中一組患者接受抗癲癇藥物治療，並與另一組類似接受無活性藥物或不同治療比較。作者發現，沒有隨機對照試驗。他們找其他沒有高品質證據的研究。這些矛盾的結果就已經有利於抗癲癇藥物的使用。這個回顧作者的結論表示，就這一主題，還需要做更好的研究，就目前而言，沒有明確的證據，以支持對於長期硬膜下血腫患者需要經常使用抗癲癇藥物。