柴贝止痫汤添加治疗难治性癫痫复杂部分性发作的临床研究

目的观察评价刘金民教授治疗难治性癫痫经验用方柴贝止痫汤联合抗癫痫药物(anti-epileptic drugs,AEDs)治疗难治性癫痫复杂部分性发作的临床疗效和安全性。方法选择符合诊断和纳入标准的病例60例,随机分为治疗组和对照组,分别给予AEDs添加柴贝止痫汤及单纯的AEDs治疗。定期随诊并记录治疗后患者的痫性发作频率、中医症状积分及不良反应等。以痫性发作频率、中医症状积分及脑电图异常程度的改善程度作为疗效判定标准。结果在改善患者的痫性发作频率方面,经Wilcoxon秩和检验,治疗12周后,治疗组疗效优于对照组(P0.05);经χ2检验,治疗8周、12周后,治疗组疗效优于对照组(P0.05)。在改善患者的中医症状积分方面,经Repested Measures检验(Greenhouse-Geisser法校正),治疗4周、8周、12周的不同观测时点、观测时点与组别的交互作用及组别之间的差异均具有统计学意义(P0.05);经χ2检验,治疗8周、12周后,治疗组疗效优于对照组(P0.05);经秩和检验,治疗4周后,在失眠症状积分上,治疗组疗效优于对照组(P0.05),治疗8周、12周后,在胸闷、痰多、疲乏、失眠四个症状积分上,治疗组疗效优于对照组(P0.05)。结论柴贝止痫汤添加用药治疗难治性癫痫复杂部分性发作,在改善患者的痫性发作频率及中医症状积分上均有明显的优势,且随着疗程的延长,疗效逐渐显著,未发现任何不良反应。柴贝止痫汤添加治疗难治性癫痫复杂部分性发作安全、有效。     

Therapeutic choices in convulsive status epilepticus

Introduction: Convulsive status epilepticus (SE) is one of the most frequent and severe neurological emergencies in both adults and children. A timely administration of appropriate antiepileptic drugs (AEDs) can stop seizures early and markedly improve outcome.

Areas covered: The main treatment strategies for SE are reviewed with an emphasis on initial treatments. The established first-line treatment consists of benzodiazepines, most frequently intravenous lorazepam. Benzodiazepines that do not require intravenous administration like intranasal midazolam or intramuscular midazolam are becoming more popular because of easier administration in the field. Other benzodiazepines may also be effective. After treatment with benzodiazepines, treatment with fosphenytoin and phenobarbital is usually recommended. Other intravenously available AEDs, such as valproate and levetiracetam, may be as effective and safe as fosphenytoin and phenobarbital, have a faster infusion time and better pharmacokinetic profile. The rationale behind the need for an early treatment of SE is discussed. The real-time delays of AED administration in clinical practice are described.

Expert opinion: There is limited evidence to support what the best initial benzodiazepine or the best non-benzodiazepine AED is. Recent and developing multicenter trials are evaluating the best treatment options and will likely modify the recommended treatment choices in SE in the near future. Additionally, more research is needed to understand how different treatment options modify prognosis in SE. Timely implementation of care protocols to minimize treatment delays is crucial.     

循证护理在小儿热性惊厥护理中的实践

目的：探讨循证护理在小儿热性惊厥护理中的效果。方法收集2010年1月-2014年12月于该院就诊的小儿热性惊厥患者180例,随机分为两组各90例,对照组采用常规护理模式,实验组在常规护理基础上采用循证护理方式,通过确定护理诊断,查阅相关文献,选择最佳护理证据,制定个体化干预措施。结果对照组再次发生惊厥频率为8.9%,实验组无再次惊厥的发生,两组差异有统计学意义（P=0.012）;实验组护理满意度显著优于对照组（98%VS87%,P=0.003）。结论循证护理在小儿热性惊厥护理中可协助护理人员制定高效准确的护理措施,减少再次出现惊厥的频率,提高护理满意度。     

Febrile seizures following measles and varicella vaccines in young children in Australia

BackgroundFebrile seizures (FS) are common in childhood with incidence peaking in the second year of life when measles and varicella-containing vaccines are administered. This study aimed to examine the vaccine-attributable risk of FS following separate administration of MMR and monovalent varicella vaccines (VV) prior to a planned change to MMRV as the second dose of measles-containing vaccine at 18 months of age.MethodsAll FS cases in children aged <5 years from 1st January 2012 to 30th April 2013 were identified from emergency department (ED) and inpatient databases at five Australian tertiary paediatric hospitals participating in PAEDS (Paediatric Active Enhanced Disease Surveillance). Immunization records were obtained from the Australian Childhood Immunization Register (ACIR). The relative incidence (RI) of FS following MMR dose 1 (MMR1) and VV in children aged 11–23 months was determined using the self-controlled case series (SCCS) method and used to calculate attributable risk.ResultsThere were 2013 FS episodes in 1761 children. The peak age at FS was 18 months. The risk of FS was significantly increased 5–12 days post receipt of MMR1 at 12 months (RI = 1.9 [95% CI: 1.3–2.9]), but not after VV at 18 months (RI = 0.6 [95% CI: 0.3–1.2]. The estimated excess annual number of FS post MMR1 was 24 per 100,000 vaccinated children aged 11–23 months (95% CI = 7–49 cases per 100,000) or 1 per 4167 doses.ConclusionsOur study detected the expected increased FS risk post MMR1 vaccine at 12 months, but monovalent varicella vaccine at age 18 months was not associated with increased risk of FS. This provides baseline data to assess the risk of FS post MMRV, introduced in Australia as the second dose of measles-containing vaccine at 18 months of age in July 2013.     

Therapeutic Outcomes and Prognostic Factors in Childhood Absence Epilepsy

MethodsSixty-seven patients with typical CAE were retrospectively enrolled at the Korea University Medical Center. We reviewed patients'' clinical characteristics, including age of seizure onset, seizure-free interval, duration of seizure-free period, freedom from treatment failure, breakthrough seizures frequency, and electroencephalogram (EEG) findings.ResultsThe age at seizure onset was 7.9±2.7 years (mean±SD), and follow-up duration was 4.4±3.7 years. Initially, 22 children were treated with ESM (32.8%), 23 with VPA (34.3%), 14 with LTG (20.9%), and 8 with VPA-LTG combination (11.9%). After 48 months of therapy, the rate of freedom from treatment failure was significantly higher for the VPA-LTG combination therapy than in the three monotherapy groups (p=0.012). The treatment dose administrated in the VPA-LTG combination group was less than that in the VPA and LTG monotherapy groups. The shorter interval to loss of 3-Hz spike-and-wave complexes and the presence of occipital intermittent rhythmic delta activity on EEG were significant factors predicting good treatment response.ConclusionsThis study showed that low-dose VPA-LTG combination therapy has a good efficacy and fewer side effects than other treatments, and it should thus be considered as a firstline therapy in absence epilepsy.