目的:急性反复发作和惊厥性癫痫持续状态是危重患儿常见的神经系统急症。该研究的目的是评估静脉注射拉科沙胺在急性重复性癫痫发作和惊厥性癫痫持续状态的危重患儿中的有效性和安全性。
方法:这项回顾性研究包括2017年10月至2022年9月因急性重复性癫痫发作或惊厥性癫痫持续状态而接受静脉注射拉科沙胺的儿童,并在三级医疗中心接受儿科重症监护病房。纳入新开始静脉注射拉科沙胺的儿童,并将其分为两组:(a)以前健康的儿童,和(b)癫痫病史和接受抗癫痫药物治疗。功效定义为在施用拉科沙胺后72小时内癫痫发作停止。使用预定义的标准定义不良反应,大多数在前7天进行了评估。
结果:67名儿童入学,其中女孩25人(37.3%),男孩42人(62.7%),平均年龄7.20±5.66岁。其中,30例(44.8%)急性反复发作,37例(55.2%)有惊厥性癫痫持续状态。癫痫发作类型为局灶性发作(n=34,50.7%),全身发作(n=27,40.3%),混合型(n=6,9.0%)。在以前健康的人群中,9例急性反复发作,23例惊厥性癫痫持续状态,当使用拉科沙胺作为第一至第四选择的抗癫痫药物时,癫痫发作停止率为100.0%,85.7%,40.0%,50.0%,分别,与73.7%相比,54.5%,100.0%,癫痫患者中的0.0%(21例急性重复性癫痫发作,14例惊厥性癫痫持续状态)。16例(23.9%)患者出现心动过缓,1例(1.5%)患者出现皮疹。
结论:早期使用静脉注射拉科沙胺治疗危重患儿急性重复性癫痫发作和惊厥性癫痫持续状态有效,副作用可接受。包括4岁以下的幼儿和儿童以及病因不同的儿童。
结论:急性重复性癫痫发作和惊厥性癫痫持续状态是儿科重症监护病房(PICU)中常见的神经系统急症,传统的静脉内抗癫痫药物(ASM)包括苯妥英钠,丙戊酸,左乙拉西坦,还有苯巴比妥.在这项研究中,我们根据患者的癫痫病史和不同病因对患者进行了分类.我们观察到早期使用拉科沙胺,即使在年幼的婴儿中,具有良好的疗效和安全性。
OBJECTIVE: Acute repetitive seizures and convulsive status epilepticus are common neurological emergencies in critically ill children. The aim of the study was to evaluate the effectiveness and safety of intravenous
lacosamide in critically ill children with acute repetitive seizures and convulsive status epilepticus.
METHODS: This retrospective study included children who received intravenous
lacosamide for acute repetitive seizures or convulsive status epilepticus from October 2017 to September 2022 and were admitted to the pediatric intensive care unit at a tertiary medical center. Children who were newly started on intravenous
lacosamide were included and divided into two groups: (a) previously healthy, and (b) history of epilepsy and receiving antiseizure medications. Efficacy was defined as the cessation of seizures within 72 h of administering
lacosamide. Adverse effects were defined using predefined criteria, and most were evaluated during the first 7 days.
RESULTS: Sixty-seven children were enrolled, including 25 (37.3%) girls and 42 (62.7%) boys with a mean age of 7.20 ± 5.66 years. Among them, 30 (44.8%) had acute repetitive seizures, and 37 (55.2%) had convulsive status epilepticus. The seizure types were focal onset (n = 34, 50.7%), generalized onset (n = 27, 40.3%), and mixed type (n = 6, 9.0%). In the previously healthy group, 9 patients had acute repetitive seizures and 23 had convulsive status epilepticus, and the rates of seizure cessation when lacosamide was used as the first to fourth choice of antiseizure medication were 100.0%, 85.7%, 40.0%, and 50.0%, respectively, compared to 73.7%, 54.5%, 100.0%, and 0.0% in the patients with epilepsy (21 had acute repetitive seizures and 14 had convulsive status epilepticus). Sixteen (23.9%) patients developed bradycardia and 1 (1.5%) patient developed a rash.
CONCLUSIONS: The early use of intravenous lacosamide was effective with acceptable side effects in treating acute repetitive seizures and convulsive status epilepticus in critically ill children, including young infants and children less than 4 years old and those with different etiologies.
CONCLUSIONS: Acute repetitive seizures and convulsive status epilepticus are common neurological emergencies in pediatric intensive care units (PICUs), traditional intravenous antiseizure medications (ASMs) include phenytoin, valproic acid, levetiracetam, and phenobarbital. In this study, we categorized patients based on their epilepsy history and different etiologies. We observed that early use of
lacosamide, even in young infants, demonstrated good efficacy and safety.