급성 지속성 발작 소아환자에서 정맥내 levetiracetam 의 효능과 안전성
Intravenous Levetiracetam in Children with Acute Prolonged Seizures
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목적: 급성 반복성 발작과 뇌전증 지속 상태는 소아에 있어서 중요한 응급 상황에 해당되므로 본 연구는 이러한 상황에서 정맥내 levetiracetam의효능과 안전성에 대해 알아보고자 하였다. 방법: 이번 연구는 2010년 4월부터 2012년 9월까지 서울아산병원 소아청소년병원에 서 정맥내 levetiracetam이 투여된 급성 반복성 발작 및 뇌전증 지속 상태 환자 91명을 대상으로 하였고,각각 기저질환, 발작형태, 항경련제 복용력, 발열유무 등으로 분류 하여 정맥내 levetiracetam의 효능과 안전성을 비교 분석하였다. 결과: 정맥내Levetiracetam(30mg/kg)가 투여된 분석 대상 40명의 환자는 평균 나이 27개월, 53일부터 15세 사이로 분포되었다 . 그중 62.5%에 해당하는 25명의 환자는 발작 소실상태를 유지하였다 . 정맥내 levetiracetam의 효능은 다른 경련 형태에 비해 전신강직간대발작에서 유의하게 높게 나타났으나( P=0.024)다른 임상적 요인들과의 관련성은 명확하지 않았다. 4명의 환자에서 흥분성 증가 및 보챔등의 부작용이 확인되었고 1명의 환자는 호흡감소로 levetiracetam을 중단했다 . 결론: 본 연구는 급성 지속성 발작, 특히 전신강직간대발작 소아에서 정맥내 levetiracetam의 일관된 부하 용량에 대한 효능과 안전성을 확인할 수 있었다. 통상적으로 투여되고 있는 항경련제를 대체할만한 역할을 알아보기 위해 향후 전향적 무작위배정에 의한 연구 등이 이루어져야하겠다 .
Abstract
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.
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