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Safety and efficacy of lacosamide versus phenytoin for refractory seizures in neurosurgical patients
BMJ Neurology Open Pub Date : 2021-06-01 , DOI: 10.1136/bmjno-2021-000144
Sarah Schaidle 1 , Kasey Greathouse 1 , Deepika McConnell 1
Affiliation  

Background Postoperative neurosurgical patients have increased risk of seizures. Traditional anti-epileptics, such as phenytoin, are not always effective and cause adverse effects. Levetiracetam is the first-line therapy due to its similar efficacy and more favourable side effect profile. However, many patients continue to seize despite adequate dosing. Lacosamide has been used for refractory seizures and may offer similar seizure control without the negative aspects of traditional agents. The purpose of this study is to evaluate if lacosamide is as safe and effective as phenytoin in terminating seizures in neurosurgical patients already on levetiracetam. Methods This retrospective, single-centre cohort study identified neurosurgical intensive care unit (ICU) patients ≥18 years old who had received levetiracetam plus either phenytoin or lacosamide at Northwestern Memorial Hospital between 1 January 2016 and 31 August 2017. The primary endpoint was treatment failure and the secondary endpoint was safety assessed by liver function tests, blood pressure, heart rate and ECG. Results 70 patients were included in this study, 52 in the phenytoin group and 18 in the lacosamide group. Both phenytoin and lacosamide groups had similar treatment failure rates (25% vs 22% respectively, p=1). Phenytoin use resulted in a mean decrease in systolic blood pressure of 20.9 mm Hg compared with 9.8 mm Hg in the lacosamide group (p=0.019). There were no statistically significant differences in the rates of other adverse effects. Conclusions The use of lacosamide for refractory seizures in neurosurgical ICU patients was associated with similar failure rates, but fewer adverse effects when compared with phenytoin. Data are available upon reasonable request.

中文翻译:

拉考沙胺与苯妥英对神经外科患者难治性癫痫发作的安全性和有效性

背景 术后神经外科患者癫痫发作的风险增加。传统的抗癫痫药,如苯妥英钠,并不总是有效并会引起不良反应。左乙拉西坦因其相似的疗效和更有利的副作用而成为一线疗法。然而,尽管剂量充足,许多患者仍继续癫痫发作。拉考沙胺已用于难治性癫痫发作,并且可能提供类似的癫痫发作控制,而没有传统药物的负面影响。本研究的目的是评估拉考沙胺在终止已经服用左乙拉西坦的神经外科患者癫痫发作方面是否与苯妥英一样安全有效。方法本次回顾,单中心队列研究确定了 2016 年 1 月 1 日至 2017 年 8 月 31 日期间在西北纪念医院接受左乙拉西坦加苯妥英或拉考沙胺的 18 岁以上神经外科重症监护病房 (ICU) 患者。主要终点是治疗失败和次要终点是通过肝功能测试、血压、心率和心电图评估的安全性。结果本研究共纳入70例患者,其中苯妥英组52例,拉考沙胺组18例。苯妥英和拉考沙胺组的治疗失败率相似(分别为 25% 和 22%,p=1)。与拉考沙胺组的 9.8 mm Hg 相比,苯妥英钠的使用导致收缩压平均降低 20.9 mm Hg (p=0.019)。其他不良反应发生率无统计学差异。结论 与苯妥英相比,使用拉考沙胺治疗神经外科 ICU 患者的难治性癫痫发作的失败率相似,但副作用较少。可根据合理要求提供数据。
更新日期:2021-06-24
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