左乙拉西坦、丙戊酸钠、苯巴比妥预防大鼠反复热性惊厥疗效观察
程敏 黄志 李思秀.重庆医科大学儿童医院神经内科 《中国当代儿科杂志》2010,7:573-575.四川大学华西第二医院小儿科肖侠明
目的比较左乙拉西坦、丙戊酸钠、苯巴比妥对大鼠反复热性惊厥的预防作用的差异,指导临床选药。方法 60只Wistar大鼠,随机分为4组,分别每日灌服左乙拉西坦（200mg/kg）、丙戊酸钠（250mg/kg）、苯巴比妥（30mg/kg）及生理盐水（8mL/kg）。连续灌服5d后,用热水浴（45℃）诱导热性惊厥,观察其热性惊厥潜伏期、惊厥持续时间、惊厥严重程度改变情况。结果大鼠用药后,3个药物干预组惊厥潜伏期延长、惊厥持续时间缩短,惊厥严重程度也明显减轻,与对照组比较差异有统计学意义（P〈0.05或0.01）,其中苯巴比妥组惊厥持续时间最短,惊厥严重程度最轻;左乙拉西坦组与丙戊酸钠组差异无统计学意义。结论左乙拉西坦与丙戊酸钠、苯巴比妥比较均能有效预防大鼠反复热性惊厥,其中苯巴比妥疗效较好,左乙拉西坦与丙戊酸钠疗效无差异。
Prophylactic efficacy of levetiracetam, valproate or phenobarbital on febrile convulsions in rats.Cheng M, Huang Z, Li SX.
Zhongguo Dang Dai Er Ke Za Zhi. 2010 ;12(7):573-5.
OBJECTIVE:To study and compare the prophylatic efficacy of levetiracetam, valproate and phenobarbital on febrile convulsions in rats.METHODS:Sixty Wistar rats were randomly administered with levetiracetam (200 mg/kg), valproate (250 mg/kg), phenobarbital (30 mg/kg) or normal saline (8 ml/kg) for 5 days. Five days later, febrile convulsions were induced by hyperthermal bath (45 Celcius degree). The latency, duration and the severity of seizures were observed.RESULTS:In all the three drug-treated groups, the latency was significantly prolonged, and the duration and the severity of seizures were notably reduced compared with the saline group (P<0.05 or 0.01). The phenobarbital group had the shortest duration of seizures and the least severe seizures among the three drug-treated groups. There were no significant differences between the levetiracetam and valproate groups.CONCLUSIONS:Continuous administration of levetiracetam, valproate or phenobarbital is effective in preventing recurrent febrile convulsions in rats. Phenobarbital appears to be more effective than levetiracetam and valproate. There were no significant differences in the prophylactic efficacy between levetiracetam and valproate.
New aspects in prevention of febrile convulsions.
Siemes H.Klin Padiatr. 1992 Mar-Apr;204(2):67-71.
In general, febrile convulsions have a good prognosis. The risk of death or neurologic and mental handicap is low. Though the risk of epilepsy is increased, there is no evidence that anticonvulsant treatment can prevent occurrence of later epilepsy. The aim of anticonvulsive prophylaxis is reduction of the rate of recurrences of febrile convulsions. Recent results point against the assumption that these can be prevented by long-term anticonvulsive treatment with phenobarbital or valproate. An alternative for longterm prophylaxis is intermittent short-term rectal application of diazepam suggested for children with a hightened risk of recurrences. Long-term prophylaxis with phenobarbital should only be considered in a small number of selective children.
Febrile seizures: treatment and prognosis.
Knudsen FU.Epilepsia. 2000 41(1):2-9.Epilepsia. 2000 Jan;41(1):2-9.
Recent epidemiologic data indicate that the vast majority of children with febrile seizures have a normal longterm outcome. A precise knowledge of the short- and long-term outcome with or without treatment, and short- and long-term side effects is an important prerequisite for assessing the various treatment strategies. We focus on the impact of short-term or prophylactic treatment on the short- and long-term outcome of various types of febrile seizures. There is universal agreement that daily prophylaxis with antiepileptic agents should never be used routinely in simple febrile seizures, but only in highly selected cases, if at all. Intermittent diazepam (DZP) prophylaxis at times of fever may or may not reduce the recurrence rate, but it does not appear to improve the long-term outcome as compared with short-term seizure control. The treatment may be used to reduce the recurrence rate for a small arbitrarily defined group with multiple simple febrile seizures, complex febrile seizures, especially focal, prolonged or both, febrile status, and when parental anxiety is severe. However, there is no evidence that treatment of simple febrile seizures can prevent the rare cases of laterepilepsy, and many children with complex febrile seizures have a benign long-term outcome, even without treatment. Many prefer a "wait and see" policy. An attractive alternative is to treat new febrile seizures with rectal DZP in solution at seizure onset, given by the parents at home to prevent febrile status. Newer, less well documented short-term strategies include nasal, oral, or rectal administration of other benzodiazepines. Short-term seizure control of febrile status and careful parental counseling are the two most important targets of treatment.
Febrile seizures are most common seizures in childhood (2-4%). Children with simple febrile seizures only have a slightly increased risk of epilepsy. Recurrences are common. Diagnostic ascertainment is easy, most evaluations simple, diagnostic routine schedules almost not necessary. Prophylactic antipyretic or anticonvulsant therapies are not recommended. Administration of rectal diazepam at home in case of recurrence is useful. Adequate therapeutical approach also includes physicians guidance and information for the dramatically frightened parents who think their child was about to die. Only complex febrile seizures with high risk of subsequent epilepsy may indicate intermittent diazepam prophylaxis or even continuous anticonvulsant treatment in case of a beginning epileptic syndrome.