新生儿惊厥精品.ppt

Off-Label Use of Antiepileptic Drugs for the Treatment of Neonatal Seizures 适应症外应用抗癫痫药物治疗新生儿惊厥 Faye S. Silverstein, MD* and Donna M. Ferriero, MD? PEDIATRIC NEUROLOGY 2008 Vol. 39 No. 2 * 在过去10年的儿童神经病学的治疗实践中，几种新型抗癫痫药物得到了广泛的接受并应用，而且一些报道也表明其中某些抗癫痫药物正在应用于新生儿惊厥的治疗 为了了解这种临床实践的进展，学者收集了儿童神经病学专家对于新型抗癫痫药物治疗新生儿惊厥的建议。提到托吡酯和左乙垃西坦这两种药物比其他新型抗癫痫药物更被推荐使用，所以我们焦点集中在这两种药物上 * Methods Surveys were distributed at the 2007 Annual Meeting of the Child Neurology Society. Responses from 55 pediatric neurologists were analyzed. Thirty-nine practiced in the United States, 11 in Canada, and 5 in other countries. * Results Over 70% (40/55) recommended the treatment of neonatal seizures with one or both of levetiracetam and topiramate only one respondent indicated that such treatment was not implemented. 47% (26/55) recommended levetiracetam 55% (30/55) recommended topiramate 16 (29%) advised treatment with both drugs 14 (25%) recommended topiramate, but not levetiracetam 10 (18%)recommended levetiracetam, but not topiramate 17 (33%) indicated that they had recommended treatment with other novel agents. The most frequently cited agents were valproic acid in 4 cases, and lidocaine, zonisamide, and oxcarbamazepine each in 3 cases * Results No side effects were reported in levetiracetam-treated neonates The 9 cited side effects in topiramate-treated infants included metabolic acidosis (4 cases) with transient hyperammonemia in one, and irritability or feeding problems (5 cases) * Discussion Many practical challenges must be addressed to implement clinical trials of new antiepileptic drugs in neonates. A recent survey of neurologists and neonatologists suggested that it would be impossible to conduct a placebocontrolled trial with a new anticonvulsant drug in the current medical environment. 对于治疗新生儿惊厥，新的抗癫痫药物需要更多的临床试验，这是一个挑战 一项调查表明很多神经学者和新生儿专家认为在目前的医疗环境下，不可能对新的抗癫痫药物进行安慰剂对照试验 * Discussion Rigorous long-term foll