RESUMO
PURPOSE: Acute repetitive seizures and status epilepticus constitute one of the major medical emergencies in children. The aim of this study was to evaluate the effectiveness and safety of intravenous (IV) levetiracetam in children with these conditions. METHODS: We reviewed medical records of the patients who received IV levetiracetam (LEV) to treat acute repetitive seizures or status epilepticus from April, 2010 to September, 2012. Patients were sub-grouped for evaluating the effectiveness and safety of IV LEV according to their underlying etiology, seizure types, previous antiepileptic medication, and febrile conditions at the time of seizures. RESULTS: Forty patients (age range, 53 day to 15 years) were treated with 30 mg/kg of IV levetiracetam. Twenty five of 40 patients (62.5%) became and remained seizure-free. IV levetiracetam was more effective in patients with generalized tonic clonic seizures than those with other seizure types (P=0.024). No other clinical factors affected the efficacy of IV levetiracetam. Irritability and aggressive behavior were noted in four children during the maintenance and one of whom needed to discontinue LEV. CONCLUSION: This study showed that IV levetiracetam therapy was effective and safe in children with acute prolonged seizures, especially with generalized tonic clonic seizures. Further randomized controlled studies are needed to determine the efficacy and safety of LEV over the conventional IV antiepileptic drugs.
Assuntos
Criança , Humanos , Anticonvulsivantes , Emergências , Prontuários Médicos , Convulsões , Estado EpilépticoRESUMO
Objectiye To observe the prevalence of prolonged seizures and the changes of biochemical markers of myocardial injury in patients with prolonged seizures after modified electroconvulsive therapy(MECT).Methods Patients treated with MECT or simulated ECT were divided into three groups.Group Ⅰ , 26 patients,experienced at least one prolonged seizure after MECT;group Ⅱ,41 selected patients, had not prolonged seizures at all during a course of MECT treatments and group Ⅲ, 31 patients, received simulated ECT.Biochemical markers of myocardial injury, including phosphocreatine kinase (CK), MR isoenzyme of phosphocreatine kinase (CK-MB), lactate dehydrogenase ( LDH ), α-hydroxybutyrate dehydrogenase ( α-HBDH ) and cardiac troponin (cTnT) ,were measured immediately, 3 hours later and on the following day after the first prolonged seizure for group Ⅰ ,the same time points as group Ⅰ after the first treatment of MECT for group Ⅱ , immediately after simulated ECT for group Ⅲ.These indexes were compared between the patients of three groups.Results The positive rate ofcTnT was 30.8%(8/26) and 17.1% (7/41)in group Ⅰ and Ⅱ respectively, but no difference was found(P＞0.05 ).CK measured immediately after MECT in patients of group Ⅰ was significantly higher than that of group Ⅲ(P ＜ 0.05 ).CK-MB (immediately), LDH ( immediately and 3 hours later) and α-HBDH ( immediately, 3 hours later and on the following day) in patients of group Ⅰ were significantly higher than those of group Ⅱ and Ⅲ measured after MECT or simulated ECT(P＜0.05 ).Conclusion More attention should be paid that absolute or relative hypoxemia may lead to minor myocardial injury.