新型抗癫痫药托吡酯治疗癫痫的临床研究

目的观察托吡酯治疗癫痫的临床疗效及安全性.方法采用开放性试验,对15例难治性癫痫患者进行托吡酯添加治疗以及对61例新诊断的癫痫患者进行托吡酯单药治疗.结果15例难治性癫痫发作频率减少≥50%者10例,有效率66.7%,其中2例发作停止;61例新诊断的癫痫发作频率减少≥50%者45例,有效率73.8%,其中16例(26.2%)完全控制.不良反应发生率低,且程度较轻.结论托吡酯不论作为添加治疗或单药治疗,对多种癫痫发作形式均有良好的疗效,而且安全.     

新诊断成人癫痫患者托吡酯单药治疗疗效分析

目的研究托吡酯单药治疗成人各种类型癫痫的疗效。方法选择71例新诊断成人癫痫患者首选托吡酯治疗,回顾性分析其疗效及不良反应。结果发作完全控制33例(占46.5%),发作频率减少≥75%10例(占14.1%),发作频率减少≥50%14例(占19.7%),发作频率无减少14例(占19.7%);单纯部分性发作,复杂部分性发作,全面性发作总有效率分别为85.2%,72.7%,81.8%。结论托吡酯可用于成人各种类型癫痫发作的单药治疗,且耐受性好,不良反应少。     

托吡酯对皮质发育障碍所致难治性癫痫的临床疗效

目的观察托吡酯对皮质发育障碍(DCDs)所致难治性癫痫(IE)的疗效。方法对MRI确诊的100例DCDs致IE病人给予托吡酯(100～200 mg·d~(-1))单药治疗,与基线发作频率比较疗效。结果100例中37例完全停止发作,33例发作频率减少≥75%,20例发作频率减少≥50%,托吡酯治疗DCDs致IE的总有效率90%,无明显不良反应。结论托吡酯是治疗DCDs致IE的一种安全、有效药物。     

托吡酯单药及合并用药治疗癫痫32例

目的：观察托吡酯单药及合并用药治疗癫痫的临床疗效。方法：对11例癫痫患者采用托吡酯单药治疗,对21例难治性癫痫患者采用托吡酯附加治疗,观察治疗前后癫痫发作频率变化。同时观察脑电图和药物的不良反应。结果：单药治疗组发作频率减少72．50％,总有效率为81．83％;托吡酯合并用药治疗组发作频率减少78．59％,总有效率为85．71％。脑电图明显改善。结论：托吡酯单用及合用其他药治疗各型癫痫均有效,未见明显不良反应,有较高的临床应用价值。     

托吡酯单药治疗癫痫的临床观察

目的：观察托吡酯对癫痫患者的临床疗效及耐受性。方法：选择50例癫痫患者（儿童30例，成人20例）进行托吡酯单药治疗。结果；儿童30例，发作频率减少≥50％者25例（80％），其中完全控制者8例（26．7％），成人20例，发作频率减少≥50％者14例（70％），其中完全控制者5例（20％），就发作类型而言，复杂部分性发作，单纯部分性发作和全身性强直－阵挛发作，有效率分别为54％，80％及85％，结论：托吡酯单药治疗对成人和儿童的多种癫痫发作类型有较好的疗效，且不良反应轻微，多可耐受。     

托吡酯治疗难治性癫痫32例

目的：观察托吡酯辅治难治性癫痫的药效和安全性。方法：对32例难治性癫痫患者进行加用托吡酯治疗开放性自身对照研究。结果：发作减少≥50%例,减少26％－49％4例,疗效较佳;各种类型癫痫之间发作减少差异不显著;与不同抗癫痫药物合用疗效无差异。结论：托吡酯是一种有效的广谱抗癫痫药,能与常用抗癫痫药物合用。     

托吡酯单药治疗不同类型癫痫的疗效评价

目的进行托吡酯(妥泰)单药治疗癫痫的疗效评价.方法选择60例癫痫患者,应用托吡酯单药治疗20周.入组前观察并记录基础发作频率.剂量从 25 mg*d-1开始,每周增加 25 mg,共8周,达到有效剂量或 200 mg*d-1后维持治疗12周,观察癫痫发作频率变化及不良反应.结果发作完全控制31例(51.7%),发作减少≥75% 14例(23.3%),发作减少≥50% 4例(6.7%),发作减少<50% 11例(18.3%).发作频率低,病程短的病例,完全控制比例高.治疗过程中无严重不良反应.结论托吡酯可作为初发各型癫痫病人常规单药治疗药物,且耐受性、安全性好.剂量应充分考虑个体化的原则,一般病人用量不超过 100 mg*d-1.     

托吡酯加用传统抗癫痫药治疗难治性癫痫部分性发作16例

目的：观察托吡酯加用传统抗癫痫药对难治性癫痫部分发作治疗的临床疗效和耐受性。方法：对16例难治性部分性发作患者加用托吡酯进行治疗,25mg/d为起始剂量,每周增加25mg,至200mg/d维持治疗,观察加用治疗前后癫痫发作频率的改变和耐受性。结果：观察24周后7例（43．8％）发作频率减少≥50％,其中3例（18．8％）停止发作,2例（12．5％）发作频率减少26％－49％,5例发作频率减少≤25％,1例发作频率明显增加,1例观察12周后失访。结论：托吡酯作为具有多重作用机制的抗癫痫新药,加用治疗难治性癫痫部分性发作的总有效率为56．3％（9／16）,无明显的必须停药的不良反应,耐受性良好。     

托吡酯单药或添加治疗儿童各型癫痫的临床观察

目的:研究托吡酯单药或添加治疗小儿癫痫的疗效与安全性.方法:选取100例癫痫患儿,其中52例原来使用的抗癫痫药种类和剂量不变,将托吡酯作为辅助治疗药物,从0.50～1.00 mg/(kg·d)开始,每周增加0.50～1.00 mg/(kg·d),目标剂量4.00～8.00 mg/(kg·d),根据癫痫发作情况调整托吡酯剂量.48例未使用过抗癫痫药物治疗的癫痫患儿单用托吡酯治疗,起始剂量为1.5 mg/(kg·d),每周增加0.50～1.00 mg/(kg·d),目标剂量8.00 mg/(kg·d).结果:添加治疗组有效率71.15%,单药治疗组有效率87.50%,均显示较好疗效,两组不良反应均较少且轻微.结论:托吡酯单药治疗和作为添加药物治疗小儿各型癫痫发作均有较好的疗效,不良反应较少.     

托吡酯治疗特发性全面性强直阵挛发作疗效观察

目的 探讨托吡酯治疗特发性全面性强直阵挛发作(GTCS)的效果及临床安全性.方法 将68例GTCS患者随机分为两组,38例使用托吡酯200mg/d;30例使用丙戊酸钠800mg/d,治疗12周观察其疗效.结果 托吡酯组38例患者中发作减少≥50%者为65.8%,发作减少≥75%者为47.4%,发作停止者为36.8%.丙戊酸钠组中发作减少≥50%者为63.3%,发作减少≥75%者为46.7%,发作停止者为36.7%.两组间无显著性差异(P＞0.05).结论 托吡酯单药治疗特发性全面性强直阵挛发作与丙戊酸疗效相当,但安全性更高,适合临床应用.     

几种新癫痫药分别联合丙戊酸钠治疗难治性癫痫的对比

目的：探讨部分难治性癫痫（RE）在添加拉莫三嗪（LTG）或奥卡西平（OXC）或托吡酯（TPM）联合丙戊酸钠（VPA）治疗的临床疗效。方法累积收集2009年1月~2014年1月符合标准的212例难治性部分性癫痫患者,对照治疗3个月前癫痫发作频度,并对治疗2年结束后的疗效、不良反应（ADR）及安全性和脑电图进行自身分析对比。结果患者应用LTG或OXC或TPM联合VPA治疗RE 2年结束后,患者发作频率均比用药前明显减少,患者治疗结束后的总有效率分别为89%、88.5%、78.1%, ADR的发生率分别为9.6%、19.2%、21.9%,脑电图总的好转率分别为89.9%、78.5%、76.9%。结论 LTG或OXC或TPM联合VPA治疗RE患者的疗效确切,耐受性好,安全性高, ADR轻。     

Topiramate: a review of its use in childhood epilepsy

Topiramate is an antiepileptic drug (AED) which appears to have a broad range of antiseizure activity in humans. A previous overview focused primarily on results of trials of topiramate in adults with epilepsy, and this review highlights the use of topiramate in children. Clinical trials have shown that topiramate is effective when used adjunctively in children with refractory partial-onset seizures and generalised tonic-clonic seizures. The drug significantly reduced seizure frequency compared with placebo in children with partial-onset epilepsy after 16 weeks of double-blind adjunctive treatment (33.1 vs 10.5%); the frequency of secondarily generalised seizures was also markedly reduced. During a nonblind extension of this trial, the mean dosage was titrated from 4.8 to 9 mg/kg/day and further reductions in the frequency of seizures were observed (71% compared with prestudy levels). In 2 mixed adult/paediatric populations with primary generalised tonic-clonic seizures, topiramate (target dosage 5.2 to 9.3 mg/kg/day) reduced the seizure rate compared with those receiving placebo. This difference was significant in one trial (56.7 vs 9%) but not in another (57.1 vs 33.2%). A subanalysis of the paediatric patients found that the favourable effect of topiramate on seizure rates was not age-related. Topiramate (median average dosage 5.1 mg/kg/day) was also found to be useful as adjunctive therapy in the management of Lennox-Gastaut syndrome and significantly reduced the mean frequency of drop attacks by 14.8% compared with an increase of 5.1% with placebo. Further gains in seizure control were made in a nonblind extension of this trial where the mean topiramate dosage was 10 mg/kg/day. Nine of 11 patients in 1 pilot trial of children with otherwise intractable West syndrome, and 5 of 10 in another, achieved a > or =50% reduction in seizure rate with topiramate (target dosage up to 24 mg/kg/day). In an 18-month extension of the former trial (mean dosage 29 mg/kg/day) a > or =50% reduction in seizures was maintained in 7 of 11 children. Adverse events associated with adjunctive topiramate therapy in children were predominantly neuropsychiatric and generally mild to moderate in severity. Behavioural and cognitive problems do occur and are a limiting factor in some children. Also, weight loss can be problematical in some individuals. Withdrawal rates were low in the controlled trials (4.8%), but appear to be more frequent in noncomparative and post-marketing studies. CONCLUSION: Well controlled studies have demonstrated that topiramate is an effective agent for the adjunctive therapy of partial and generalised tonic-clonic seizures in children. Treatment-limiting adverse events do occur, but these may be managed by slow titration. Although comparative studies with the other newer AEDs used in adjuntive therapy are required, topiramate is an important extension to the range of drugs that may be used to treat refractory epilepsy in children.     

托吡酯加用治疗难治性癫痫发作218例的多中心临床研究

目的 :观察托吡酯加用治疗多种类型癫痫发作的临床疗效。方法 :2 18名癫痫病人 ,均为用过各种抗癫痫药物治疗效果不佳的难治性癫痫 ;采用逐渐加量法 ,加量期 8wk ,托吡酯开始剂量为 2 5mg·d- 1,目标剂量为 2 0 0mg·d- 1,观察 12wk后进入延长期。结果 :治疗后 ,2 6例病人 (12 .3% )发作完全消失 ,5 9例 (2 8.0 % )发作减少≥ 75 % ;10 7例(5 0 .7% )发作减少≥ 5 0 %～ <75 % ;19例(9 .0 % )无效。 5例 (2 .3% )因严重不良反应而中断治疗。 2例失访 (原因不明 )。结论 :托吡酯是一种非常有效的新型抗癫痫药物 ,值得临床推广使用     

颞叶癫痫的手术治疗(附26例报告)

目的提高药物难治性癫痫的致痫灶精确定位和外科治疗水平。方法对26例颞叶癫痫患者应用长程视频脑电进行术前监测定位和皮层电极、深部电极进行术中定位;采用显微外科技术进行病灶+颞叶切除或颞叶+海马杏仁核切除。结果26例患者根据脑电图,18例患者根据MRI检查定位了致痫灶。术后无病死和严重并发症,服用抗癫痫药物减少;随访6～18个月,1级16例,2级6例,3级4例。结论长程视频脑电图和MRI检查是定位癫痫灶可靠的检查方法。应用显微外科技术可减少并发症,取得较好的治疗效果。     

Evaluation of health status in epilepsy using the EQ-5D questionnaire: a prospective, observational, 6-month study of adjunctive therapy with anti-epileptic drugs

AIMS: The aims of this project were to evaluate the impact of adjunctive treatment with an anti-epileptic drug (AED) on the health status of people with epilepsy and to investigate how seizure frequency affects their health status. METHODS: Adult epilepsy patients, refractory to current treatment, were included in this prospective observational study. Patients commencing adjunctive therapy with one of five AEDs (topiramate, lamotrigine, gabapentin, clobazam, vigabatrin) were eligible for inclusion. The study took place at the outpatient clinics of the National Hospital for Neurology and Neurosurgery, Queen Square, London. Patients completed the EQ-5D, a generic health status measure, at baseline and again after 3 and 6 months. Information was also collected on medications and seizure frequency. RESULTS: In total, 125 patients entered the study and were followed up for 6 months. Patients treated with topiramate had a significant increase (p < 0.05) in EQ-5D score from baseline, indicating an improvement in their health status whereas scores for lamotrigine, clobazam and gabapentin all showed a non-significant decline. When the data were analysed according to seizure frequency, only patients who became seizure-free on adjunctive treatment had a significant increase in their health status. The group who had a 50% reduction in seizure frequency did not have increased health status. CONCLUSIONS: In summary, adjunctive treatment with topiramate significantly increased health status as measured by the EQ-5D. These data also suggest that achievement of seizure-freedom is the key to improving health status in this patient group.     

添加托吡酯治疗癫痫的临床研究

目的：观察新型抗癫痫药托吡酯（妥泰）添加治疗癫痫的临床疗效和脑电图（EEG）变化。方法：进行开放性自身对照临床试验，对47例经临床和EEG确诊的癫痫患者在原有抗癫痫药物治疗不变的基础上，添加妥泰治疗，初始剂量为50mg.d^-1，2周后为100mg.d^-1，分2次服用，维持剂量200－400mg.d^-1。以治疗前3个月的发作频度和EEG改变为基础，治疗3个6个月后，分别观察发作频度和EEG的变化，并与治疗前进行比较。结果：添加妥泰治疗3和6个月后，发作次数明显减少，尤以治疗6个月后显著（P＜0．01），总有效率（显效＋有效）分别为61．70％和82．98％，差异显著（P＜0．01）；EEG异常率（高度和中度不正常）也由原来的23．4％和25．5％变为治疗3和6个月后的17．0％和19．1％以及0和10．6％，总异常率由原来的70．2％下降至59．6％和29．8％，差异有显著性（P＜0．01）／。结论：妥泰作为一种辅助抗癫痫药物，不仅能明显减少癫痫的发作频度，使EEG异常率显著降低，而且不良反应少，值得临床推广应用。