抗惊厥药物为新生儿癫痫发作。

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布斯D,埃文斯DJ

抗惊厥药物为新生儿癫痫发作。

科克伦数据库系统启2004年10月18日;(4):CD004218。

PubMed ID

15495087 (在PubMed

]

文摘

背景:新生儿癫痫是一种常见的问题,大多数新生儿癫痫发作与抗惊厥药物治疗。有广泛的临床实践的变化在两个这样的癫痫的诊断和治疗,这反映了缺乏明确的证据相对使用的抗惊厥药物的益处和害处。常规使用的抗惊厥药物治疗新生儿癫痫发作的需要评估。目的:评估和比较(好处和危害)不同的抗惊厥药物注射治疗的新生儿癫痫发作。必威国际app搜索策略:相关随机对照试验确定了使用电子数据库搜索的组合(MEDLINE 1966 - 2004年3月,EMBASE 1980 - 2004年3月),科克伦中央登记的对照试验(中央,Cochrane图书馆,问题1,2004)和手搜索。鉴定正在进行的或未发表的试验是企图通过联系知名作者在该领域和搜索电子注册正在进行的试验。必威国际app选择标准:所有随机或quasi-randomised控制临床试验报告数据比较以下结果:死亡率、神经发育障碍,需要额外的抗惊厥药物,需要维护在放电和抗惊厥药物不良事件(低血压需要体积或收缩药物支持、心律失常、呼吸抑郁、肝毒性)在新生儿治疗癫痫全身性抗惊厥药物与安慰剂相比,没有药物或抗惊厥药物替代。数据收集和分析:方法学质量和有效性的评估不考虑结果。第一个审稿人筛查发现的标题和摘要的研究上面的搜索策略。必威国际app全文的研究被评论家筛选潜在的相关性。 Studies meeting the pre-specified inclusion criteria were included. Relevant data were extracted and analysed separately and any disagreements were resolved by discussion. MAIN RESULTS: Only two randomised controlled trials published in full could be identified. Painter 1999 showed that both of the two most commonly used anticonvulsants (phenobarbital and phenytoin) were similarly effective (RR 1.03 95% CI 0.96 to 1.62), controlling seizures in less than fifty percent of infants. Painter 1999 did not report mortality or neurodevelopmental outcome. Boylan 2004 randomised infants who failed to respond to phenobarbital to receive either lidocaine or midazolam as second-line agents. There was a trend for lidocaine to be more effective in reducing seizure burden (RR 0.40 95% CI 0.14 to 1.17) but both groups had similarly poor long term outcomes assessed at one year. REVIEWERS' CONCLUSIONS: At present there is little evidence from randomised controlled trials to support the use of any of the anticonvulsants currently used in the neonatal period. In the literature, there remains a body of opinion that seizures should be treated because of the concern that seizures in themselves may be harmful, although this is only supported by relatively low grade evidence (Levene 2002; Massingale 1993). Development of safe and effective treatment strategies relies on future studies of high quality (randomised controlled trials with methodology that assures validity) and of sufficient size to have the power to detect clinically important reductions in mortality and severe neurodevelopmental disability in addition to any short term reduction in seizure burden.

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