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左乙拉西坦治疗新生儿难治性惊厥发作

Levetiracetam treatment for neonatal intractable seizure

摘要:

目的 观察经苯巴比妥(PB)治疗不能控制的难治性惊厥新生儿,在改换或添加左乙拉西坦(LEV)治疗后的疗效与安全性.方法 14例经临床和视频脑电图(VEEG)确认的惊厥新生儿首先接受足量PB无效或未完全控制的患儿,进一步转换为LEV口服液单药或添加治疗.首剂LEV剂量30 mg/kg,持续无发作8~12h后按15 mg/(kg·次),每日2次维持给药.对首剂LEV后8h内仍有发作者追加30 mg/kg 1剂.对持续控制48~72 h后无发作的患儿试减停PB改LEV单药治疗.经二者联合用药仍不得缓解者更改为其他抗癫(痫0药物.启用PB及LEV的第1个72 h内进行心电呼吸同步监护.对全部病例于出院后1~3个月回访并再次复查VEEG.结果 1.惊厥患儿14例中8例(57.14%)于添加LEV后发作完全控制,2例(14.29%)添加后发作减少50%以上,4例(28.57%)添加后无显效而联合或改换其他止惊药物.2.均未发现明显药物不良反应.3.出院1~3个月后随访:14例中1例患儿因严重新生儿缺氧缺血性脑病伴多器官衰竭死亡;另1例转LEV后24h发作控制且单药治疗2周出院,出院1个月后失访,随访期间无发作.余12例中7例随访中均再无发作,且生长发育及VEEG复查均正常;另5例于新生儿期后呈现各型难治性癫(痫)而先后改换或联合其他抗癫(痫)药物治疗.结论 LEV治疗新生儿惊厥具有快速显效与安全性高等优势.结合该药不存在PB等传统药物可能致脑内过度凋亡与认知损伤的研究证据,应更广泛深入开展相关临床及实验研究,以促进LEV尽早成为新生儿惊厥的一线抢救用药.

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abstracts:

Objective To investigate the efficacy and safety of Levertiracetam (LEV) in treating the neonates with intractable seizure, those who had under gone failed Phenobarbital (PB) treatment previously switched to or added LEV treatment currently.Methods Totally 14 neonates,designed as intractable seizure by clinical data and video electroencephalography(VEEG) and failed to PB treatment were enrolled in the study, and all neonates were switched to LEV or LEV + PB treatment.The initial loading dose of LEV was 30 mg/kg, followed by 15 mg/kg twice a day if symptoms were controlled 8-12 h,if not, followed by 30 mg/kg once.All neonates were switched to LEV monotherapy after the symptoms were controlled 48-72 h,if the symptoms could not be controlled by combined therapy of PB and LEV after 72 h, other therapies were administered.Electrocardiogram breath synchronous monitoring was performed during the first 72 h treatment.VEEG was performed during 1-3 months follow-up.Results (1) The symptoms of 8 (57.14%) out of 14 cases were completely controlled,2 neonates(14.29%) reduced seizure more than 50% ,4 neonates(28.57%) failed to LEV or LEV + PB treatment,as a result,all of those neonates were switched to other treatments.(2) No drug adverse effect was observed.(3) One neonate died of hypoxic-ischemic encephalopathy combined with multiple organ failure during follow-up period, 7 cases were seizure-free with normal VEEG, 5 cases were switched to or added other antiepileptic drugs because of uncontrolled symptoms, and one neonate discontinued the follow-ups.Conclusions The high efficiency and safety of LEV for the treatment of the newborn seizures were proved by small samples of patients.And currently there is no evidence to prove PB might increase neuronal excessive apoptosis of the brain and the cognitive impairment, and more clinical researches are needed to promote LEV as a gleam of rescue medications of neonatal seizure as soon as possible.

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作者: 李婕 [1] 陈曦 [1] 杨月霞 [2] 姜兰 [2] 哈斯也提·吾买尔 [2] 王晓曦 [3]
期刊: 《中华实用儿科临床杂志》2015年30卷24期 1912-1914页 ISTICPKUCSCD
栏目名称: 药物与临床
DOI: 10.3760/cma.j.issn.2095-428X.2015.24.019
发布时间: 2019-01-11
基金项目:
乌鲁木齐市科技局计划项目
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