Routine anticonvulsants for treating cerebral malaria

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Abstract
Cerebral malaria is a common complication of Plasmodium falciparum infection, and kills over a million people every year. People with cerebral malaria become unconscious, and often have protracted convulsions. It is unclear whether giving anticonvulsant drugs routinely to people with cerebral malaria will improve the outcome of treatment and prevent death. To evaluate the effect of routine anticonvulsant drugs in people with cerebral malaria. We searched the Cochrane Infectious Diseases Group Specialized Register (May 2004), CENTRAL (The Cochrane Library Issue 2, 2004), MEDLINE (1966 to May 2004), EMBASE (1988 to May 2004), LILACS (1982 to May 200), Science Citation Index (May 2004), African Index Medicus (1999), reference lists of articles, and research organizations. We also contacted the authors for additional information. Randomized and quasi‐randomized controlled trials of people with cerebral malaria. The trials compared anticonvulsant drugs started on admission to hospital with no anticonvulsant drug or placebo. Two reviewers independently extracted data from those trials eligible for inclusion. We assessed the risk of bias in the included trials by considering allocation sequence, concealment of allocation, blinding, and inclusion of all randomized participants. We used Review Manager (version 4.1) for the meta‐analysis and also explored possible sources of heterogeneity. Three trials with a total of 573 participants met the inclusion criteria. These trials all compared phenobarbitone with placebo or no treatment. In the two trials with adequate allocation concealment, death was more common in the anticonvulsant group (Risk Ratio 2.0; 95% confidence interval 1.20 to 3.33; fixed effect model). In all three trials, phenobarbitone compared with placebo or no treatment was associated with fewer convulsions (Risk Ratio 0.30; 95% confidence interval 0.19 to 0.45; fixed effect model). Routine phenobarbitone in cerebral malaria is associated with fewer convulsions but possibly more deaths. Further trials with adequate design, more participants, and different doses of anticonvulsant drugs are needed. 例行性給予抗痙攣藥物治療腦性瘧疾 腦性瘧疾是1種因為惡性瘧原蟲(Plasmodium falciparum)感染所引起的常見併發症，而且它每年會奪去超過100萬人的性命。患有腦性瘧疾的人們會變成沒有意識，而且常常會發生持久性的抽搐。目前並不清楚是否例行性給予抗痙攣藥物改善治療腦性瘧疾的結果以及預防死亡。 評估例行性給予抗痙攣藥物治療腦性瘧疾的效果。 我們搜尋Cochrane Infectious Diseases Group Specialized Register (2004年5月)、CENTRAL (Cochrane Library Issue 2, 2004)、 MEDLINE (1966年to 2004年5月)、EMBASE (1988年−2004年5月)、 LILACS (1982年 – 2004年5月)、 Science Citation Index (2004年5月)、 African Index Medicus (1999)、 文章的參考文獻以及研究機構。並與作者聯繫已取得額外資訊。. 針對患有腦性瘧疾的人們所作的隨機與半隨機對照試驗。這些試驗比較在住院的時候就開始使用抗痙攣藥物，以及不使用抗痙攣藥物或是安慰劑間之差異。 有2位審稿者從這些符合收集規定的試驗當中，獨立地擷取出了資料。針對這些被收集在內的試驗而言，我們藉由考量分配順序、隱藏分配工作、盲法，以及對所有隨機化之參與者的收集工作等方面，來評估了這些試驗在方法層面上的品質。我們使用了Review Manager(第4.1版)作統合分析，同時還探討了質異性方面的可能來源。 共有包含了573名參與者在內的3項試驗符合了收集的標準。在phenobarbitone與安慰劑或是不採取治療之間，這些試驗都曾經進行過比較。在這2份試驗當中，都已經適當地隱藏了分配的狀況，而在使用抗痙攣藥物的組別裡面，死亡的情形發生得比較多(相對風險為2.0；95%信賴區間為1.20到3.33；固定效果模型)。在這全部的3項試驗中，跟安慰劑或是不採取治療比較起來，phenobarbitone所造成的抽搐現象比較少(相對風險為0.30；95%信賴區間為0.19到0.45；固定效果模型)。 對於腦性瘧疾而言，固定地使用phenobarbitone之後所帶來的抽搐現象比較少，但是卻比較可能會造成死亡。進一步包括經過適當設計、更多參與者，以及不同劑量的抗痙攣藥物等更深入的試驗有其必要。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。 無總結