急性症状发作的预后和治疗:一个前性,多中心的观察性研究
Julia Herzig-Nichtweiß1, Farid Salih1, Sascha Berning2
1Epilepsy-Center Berlin-Brandenburg, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Charitéplatz 1, 10117, Germany.
Annals of intensive care
|September 15, 2023
概括
急性症状性发作具有较低的后续未引起的发作风险,即使有结构性原因. 长期抗发作药物没有证据支持,如果没有高风险特征,应及早停止服用.
科学领域:
- 神经学 神经学
- 神经临界护理是指神经临界护理.
- 发病学 (Epileptology) 是一个专业的学科.
背景情况:
- 急性症状性发作在神经临床护理环境中很常见.
- 长期抗发作药物 (ASM) 经常被处方以防止未引起的发作,尽管缺乏支持证据.
- 这项研究前性地评估了第一次急性症状性发作后未引起的发作复发的风险.
研究的目的:
- 评估第一个急性症状性发作后12个月累积的未引起的发作复发风险.
- 调查抗发作药物使用与发作复发之间的关联.
- 了解神经密集治疗师对ASM的治疗策略.
主要方法:
- 成年患者 (≥18岁) 首次出现急性症状性发作 (不包括状态发作) 的前性队列研究.
- 通过电话和邮件采访进行12个月的随访,以记录未引起的发作复发.
- 匿名在线调查德国神经密集医生关于他们的ASM治疗策略.
主要成果:
- 在具有结构性病因的患者中,未引起的复发的累积12个月风险为10.7% (11/122).
- 在非结构性病因 (0/19) 的患者中没有发生未引起的发作.
- 结合感染和结构病因独立增加了复发风险 (OR 11.1). 较长的ASM治疗持续时间并没有降低复发风险;在ASM治疗期间发生了7/11次复发.
结论:
- 即使是具有结构性病因的急性症状性,随后发生未引起的的风险也很低.
- 目前的证据不支持大多数患者长期治疗ASM.
- 如果没有高风险特征,如中枢神经系统感染导致结构性脑损伤,建议提前停止ASM.
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