Abstract
Objective To systematically review the efficacy and safety of intermittent use of diazepam to prevent recurrence of febrile seizure(FS)using meta-analysis methods. Methods The Cochrane Library(Issue 7,2014),PubMed,EMBASE,CBM, CNKI,VIP and Wanfang Data were searched for the randomized controlled trails( RCTs)about prophylactic use of dizapam to control FS relapse in children up to July 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data and evaluated the methodological quality of included studies. Then meta-analysis was performed using RevMan 5. 2 software,in subjects with low-,moderate- and high-risk of FS recurrence respectively. Results Nine studies involving 1 578 patients were included. The methodological quality evaluation defined generation of random sequences for randomization,allocation concealment,and blinding as high bias risk;selective result reporting,loss of follow up,and alternative sources of bias as low bias risk. Meta-analysis showed no significant difference in FS recurrence rate in 6-month treatment group and intermittent diazepam compared with the control group(RR=0. 62,95% CI:0. 34 to 1. 13,P=0. 12;RD= _0. 07,95%CI:_0. 16 to 0. 02). However,FS relapse rate was markedly decreased at 12 months treatment(RR=0. 59,95%CI:0. 38~0. 91, P=0. 02;RD= _0. 12,95%CI:_0. 22~ _0. 02)and 24 months treatment(RR=0. 54,95%CI:0. 37 to 0. 78,P=0. 001;RD= _0. 17,95%CI:_0. 27 to _0. 07),compared with the control group. The results of subgroup analysis by FS recurrence risk factors indicated that reduced FS recurrence rate was found in the moderate-risk group(6 months:RR=0. 31,95%CI:0. 15 to 0. 62,P=0. 000 9;12 months:RR=0. 39,95%CI:0. 20 to 0. 75 ,P=0. 005;24 months:RR=0. 43,95%CI:0. 24 to 0. 77,P=0. 005)and high-risk group(6 months:RR=0. 24,95%CI:0. 10 to 0. 15;12 months:RR=0. 27,P=0. 00 09. 95%CI:0. 13 to 0. 58,P=0. 000 7;24 months:RR=0. 35,95%CI:0. 19 to 0. 62,P=0. 000 4)but not in the low-risk group (6 months:RR=0. 69,95%CI:0. 40 to 1. 21,P=0. 20;12 months:RR=0. 81,95%CI:0. 47 to 1. 42,P=0. 46;24 months:RR=0. 71,95%CI:0. 45 to 1. 11,P=0. 14). No serious complications about diazepam was reported in the included studies. Conclusion Intermittent diazepam for 12 months or 24 months can effectively reduce FS recurrence rate,and shows good efficacy for moderate-risk and high-risk patients. Additional high quality studies are still expected to verify the above conclusion.关键词
热性惊厥/地西泮/抗惊厥药物/儿童/Meta分析/随机对照试验Key words
Febrile seizure/Diazepam/Anticonvulsant drug/Chlidren/Meta-analysis/Randomized controlled trial
