テオフィリン投与中の痙攣症例に関する臨床的検討 : 特に痙攣発症に影響を及ぼす因子について  [in Japanese] CLINICAL REVIEW ON PATIENTS WHO DEVELOPED SEIZURES DURING THEOPHYLLINE : Administration: Relationships with Seizure-Predisposing Factors  [in Japanese]

【目的】近年,テオフィリンの投与中に起こった痙攣をテオフィリン関連痙攣として幅広くとらえる試みから,これらの痙攣がすべて投与薬剤に起因するものとされる傾向が生じている.これらの痙攣症例の患者背景因子について調査し,起こった痙攣とテオフィリンの関与について検討した.【方法】1987年10月から2004年4月までにテオフィリン製剤を製造販売する2社に報告された,テオフィリン投与中に痙攣を発症した334例(経口剤255例,静注剤79例)を対象とし,対象症例の基礎疾患,投与方法,転帰などを検討した.【結果】痙攣症例の検討した背景因子の中では,てんかんなどの神経学的素因または痙攣の既往が最も多く,3分の2以上の症例が痙攣発症前から有していた.また,後遺症症例(死亡例を含む)の90%以上に同様の因子を有し,それらの児の発熱時に多く発症していることがわかった.後遺症の出現には,発熱が最も関連ある因子であることがわかった.また,今回の検討の中では乳幼児の中でも3歳以下と痙攣の既往がある児に後遺症症例が多かった.【結語】以上の点に留意すれば,テオフィリン投与中の痙攣を大幅に減少させることができると推察された.

Objective: In recent years, attempts have been made to broadly deem seizures developing during theophylline administration as theophylline-related seizures. Consequently, a tendency to consider all the seizures attributable to theophylline has occurred. We investigated background factors in pediatric patients with seizures to examine the involvement of theophylline in the event. Methods: Of adverse events developing during theophylline administration which were reported by two theophylline preparation manufacturers between October 1987 and April 2004, we investigated underlying disease, regimen, outcome, and other items in 255 patients with seizures provoked by oral preparations and in 79 patients with seizures provoked by intravenous preparations. Results: The most predominant factors were represented by neurological predispositions, e.g., epilepsy, and by a history of fits prior to the onset of seizures in not less than two-thirds of pediatric patients with seizures who were receiving theophylline. Furthermore, not less than 90% of pediatric patients who remained with sequelae and who died had the factors. Our investigation revealed that the factors developed predominantly when the relevant patients presented fever, aged under 3 years and had history of seizures. Conclusions: Therefore, we consider that advertence to this point is most important in administering theophylline safely.