创伤性脑损伤成人患者的抗癫痫药物治疗:系统回顾与贝叶斯网络元分析》。

Q4 Medicine Critical care explorations Pub Date : 2024-09-25 eCollection Date: 2024-10-01 DOI:10.1097/CCE.0000000000001160
Federico Angriman, Shaurya Taran, Natalia Angeloni, Catherine Devion, Jong Woo Lee, Neill K J Adhikari
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引用次数: 0

摘要

研究目的我们试图评估任何抗癫痫药物对成年脑外伤患者创伤后早期癫痫发作的有效性:数据来源:检索了从开始到 2023 年 10 月的 MEDLINE、Embase、PubMed、Cochrane Central Register of Controlled Trials 和 LILACS:我们纳入了针对成年脑外伤患者的随机试验,这些试验评估了任何抗癫痫药物与安慰剂或其他药物的比较:两名审稿人独立提取单个研究数据,并使用 Cochrane 偏倚风险工具评估研究的偏倚风险。我们关注的主要结果是早期癫痫发作的发生率(即 7 d 内);次要结果包括晚期癫痫发作和全因死亡率:采用贝叶斯网络荟萃分析法得出风险比(RRs)和 95% 可信区间(CrIs)。我们采用建议分级评估、发展和评价方法来评定研究结果的确定性。总共纳入了十项随机对照试验(1851 名参与者)。与安慰剂相比,苯妥英(RR,0.28;95% CrI,0.13-0.57;中等确定性)和左乙拉西坦(RR,0.20;95% CrI,0.07-0.60;中等确定性)与早期癫痫发作风险的降低有关。卡马西平可能与降低早期癫痫发作风险有关,但证据非常不确定(RR,0.41;95% CrI,0.12-1.27;极低确定性)。丙戊酸可能导致早期癫痫发作风险几乎没有差异,但证据非常不确定(RR,0.97;95% CrI,0.16-9.00;确定性很低)。在报告的最长随访时间内,任何抗癫痫药物对晚期癫痫发作或全因死亡风险的影响都很不确定:结论:苯妥英或左乙拉西坦能降低成年脑外伤患者早期癫痫发作的风险。还需要进一步的研究来评估所需的治疗时间和长期安全性。
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Antiseizure Medications in Adult Patients With Traumatic Brain Injury: A Systematic Review and Bayesian Network Meta-Analysis.

Objectives: We sought to evaluate the effectiveness of any antiseizure medication on the incidence of early post-traumatic seizures among adult patients with traumatic brain injury.

Data sources: MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials, and LILACS were searched from inception to October 2023.

Study selection: We included randomized trials of adult patients with traumatic brain injury evaluating any antiseizure medication compared with either placebo or another agent.

Data extraction: Two reviewers independently extracted individual study data and evaluated studies for risk of bias using the Cochrane Risk of Bias tool. Our main outcome of interest was the occurrence of early seizures (i.e., within 7 d); secondary outcomes included late-seizures and all-cause mortality.

Data synthesis: Bayesian network meta-analyses were used to derive risk ratios (RRs) alongside 95% credible intervals (CrIs). We used Grading of Recommendations Assessment, Development, and Evaluation methodology to rate the certainty in our findings. Overall, ten individual randomized controlled trials (1851 participants) were included. Compared with placebo, phenytoin (RR, 0.28; 95% CrI, 0.13-0.57; moderate certainty) and levetiracetam (RR, 0.20; 95% CrI, 0.07-0.60; moderate certainty) were associated with a reduction in the risk of early seizures. Carbamazepine may be associated with a reduced risk of early seizures, but the evidence is very uncertain (RR, 0.41; 95% CrI, 0.12-1.27; very low certainty). Valproic acid may result in little to no difference in the risk of early seizures, but the evidence is very uncertain (RR, 0.97; 95% CrI, 0.16-9.00; very low certainty). The evidence is very uncertain about the impact of any antiseizure medication on the risk of late seizures or all-cause mortality at longest reported follow-up time.

Conclusions: Phenytoin or levetiracetam reduce the risk of early seizures among adult patients with traumatic brain injury. Further research is needed to evaluate required duration of therapy and long-term safety profiles.

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