Abstract
390 patients with severe head injuries were treated with phenobarbital (PB) orally for a period of 12 months in order to determine whether this drug could reduce the incidence of posttraumatic epilepsy (PTE). An intramuscular PB dose of 2.5–3 mg/kg body weight per day was administered within 24 hours after the trauma; after 5 days, or longer if the coma persisted, the drug was administered orally. Maintenance dosage adjustments, when necessary, were based on serial plasma concentrations of the drug, sustained at between 5 and 30 μg/ml.
293 patients completed the study. 66% of these presented one risk factor, while 34% presented two or more.
6 patients (2.04%) had at least one seizure during the twelve months. Plasma drug levels at the time of the seizure, with one exception of 15 μg/ml, ranged from 20 to 28 μg/ml.
The results of the study indicate that PB administered during the first twelve months after the trauma, even at relatively low doses, can have a prophylactic effect on PTE.
Sommario
390 pazienti con gravi traumi cranici sono stati trattati con phenobarbital (PB) per via orale, per un periodo di 12 mesi, al fine di verificare se tale farmaco potesse ridurre l'incidenza dell'epilessia post-traumatica (PTE). Il PB è stato somministrato per via intramuscolare, entro 24 ore dopo il trauma, alla dose di 2.5–3 mg/kg/die; dopo 5 giorni o un periodo di tempo maggiore se il coma persisteva, il farmaco è stato somministrato per via orale. Il mantenimento del livello plasmatico, quando necessario, è stato ottenuto monitorando le concentrazioni plasmatiche del farmaco che sono state mantenute tra 5 e 30 μg/ml.
293 pazienti hanno completato lo studio. Il 66% presentava un solo fattore di rischio, mentre il 34% presentava due o più fattori di rischio associati.
6 pazienti (2.04%) hanno presentato almeno una crisi epilettica entro i 12 mesi. I livelli plasmatici del farmaco al momento della crisi, variavano fra 20 e 28 μg/ml, con una eccezione di 15 μg/ml. I risultati dello studio indicano che il PB somministrato durante i primi 12 mesi dopo il trauma, anche a dosi relativamente basse, può avere un effetto profilattico sulla PTE.
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Murri, L., Arrigo, A., Bonuccelli, U. et al. Phenobarbital in the prophylaxis of late posttraumatic seizures. Ital J Neuro Sci 13, 755–760 (1992). https://doi.org/10.1007/BF02229161
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DOI: https://doi.org/10.1007/BF02229161