苯妥英钠预防白消安致癫痫发作失败病例分析

One case of failure to prevent busulfan-induced epilepsia by phenytoin

目的探讨白消安致癫痫的预防及治疗的应用及优化。方法通过对1例苯妥英钠预防白消安致癫痫发作失败的病例进行深入分析,从药学监护角度就白消安剂型选择、预防性抗癫痫治疗的必要性、起始抗癫痫治疗的时机和抗癫痫药物的选择等问题进行讨论。结果调研认为该患者预防性抗癫痫治疗的理由充分,但白消安口服剂型对其血药浓度的影响及苯妥英钠治疗不充分可能是导致患者癫痫发作的原因之一,苯妥英钠作为预防白消安所致的癫痫发作并不是唯一选择。结论临床药师对白消安/环磷酰胺预处理方案下抗癫痫治疗方案进行探讨及优化,为临床治疗提供细节的依据。

Objective To explore the antiepileptic prophylaxis induced by busulfan.Methods By in-depth analysis of one case of busulfan-induced epilepsia,we discussed the failure reason of phenytoin antiepileptic prophylaxis focusing on busulfan formulation.Furthermore,we overviewed the evidence on the necessity of prophylactic antiepileptic treatment,the timing of starting antiepileptic therapy,the selection of antiepileptic drugs and other issues in pharmaceutical care.Results Evidence-based research led us thinking that there were sufficient reasons for prescribing prophylactic antiepileptic drugs for this patient,but oral form of busulfan and inadequate dosage of phenytoin may result in epileptic seizure.Phenytoin may not be the only choice for prevent busulfan-induced seizures.Conclusion Clinical pharmacists played a positive role in the clinical treatment on antiepileptic protocols for the patients receiving busulfan/cyclophosphamide therapy.