托吡酯联合丙戊酸钠治疗婴儿痉挛的临床观察

目的 观察托毗酯联合丙戊酸钠治疗婴儿痉挛的临床疗效.方法 将40例婴儿痉挛患儿,随机分为对照组和治疗组,每组各20例.对照组采用常规丙戊酸钠口服的治疗方法 治疗组采用托吡酯联合丙戊酸钠治疗.连续治疗3个月后比较两组的临床疗效和脑电图改善情况.结果 治疗组总有效率（95.0%）、脑电图改善情况（90.0%）均优于对照组的（70.0%和60.0%）（x2=4.32,4.80,均P〈0.05）.结论 托吡酯添加治疗婴儿痉挛症不良反应较少,临床效果良好.     

托吡酯联合丙戊酸钠治疗婴儿痉挛的临床观察

目的 观察托毗酯联合丙戊酸钠治疗婴儿痉挛的临床疗效.方法 将40例婴儿痉挛患儿,随机分为对照组和治疗组,每组各20例.对照组采用常规丙戊酸钠口服的治疗方法;治疗组采用托吡酯联合丙戊酸钠治疗.连续治疗3个月后比较两组的临床疗效和脑电图改善情况.结果 治疗组总有效率(95.0%)、脑电图改善情况(90.0%)均优于对照组的(70.0%和60.0%)(x2=4.32,4.80,均P<0.05).结论 托吡酯添加治疗婴儿痉挛症不良反应较少,临床效果良好.     

托吡酯联合丙戊酸钠治疗小儿癫痫效果观察

目的研究托吡酯联合丙戊酸钠治疗小儿癫痫疾病的临床疗效。方法 2009年3月至2011年3月我院收治的小儿癫痫患儿,抽取其中150例,按治疗方法不同分成托吡酯组、丙戊酸钠组、丙戊酸钠联合托吡酯组各50例。观察并比较三组的治疗效果和不良反应发生情况。结果联合组患儿的临床疗效明显优于丙戊酸钠组和托吡酯组,差异有统计学意义。三组不良反应发生率大体相似,差异无统计学意义。结论托吡酯联合丙戊酸钠治疗小儿癫痫疗效优于单一药物治疗,且患儿的耐受性相对较高。     

探讨丙戊酸钠联合托吡酯在小儿癫痫治疗中的疗效分析

目的 探讨应用丙戊酸钠联合托吡酯治疗小儿癫痫的临床疗效,进一步为临床治疗提供参考依据.方法 选取2012年2月至2014年2月我院收治的小儿癫痫患者70例,随机分为A、B、C三组,A组患儿应用托吡酯进行治疗,B组患儿应用丙戊酸钠,C组患儿应用丙戊酸钠联合托吡酯联合治疗,比较三组患儿临床总有效率.结果 经过治疗,A组托吡酯总有效率为83.3％,B组丙戊酸钠总有效率为79.2％,C组联合治疗总有效率为91.3％,C组与A、B组比较,P＜0.05,差异有统计学意义,A组与B组间比较差异无统计学意义.三组患儿均存在一定程度的不良反应,包括恶心、感觉异常、嗜睡以及体制变化等,但组间差异小(P＞ 0.05).结论 应用丙戊酸钠联合托吡酯治疗小儿癫痫临床疗效突出,明显优于两者单独应用,且不良反应无增加,患儿耐受良好,值得临床进一步推广和应用.     

小剂量促肾上腺皮质激素治疗婴儿痉挛症疗效观察

目的：探讨小剂量促肾上腺皮质激素（ACTH）治疗婴儿痉挛症的疗效。方法：采用回顾性研究方法,将67例婴儿痉挛症患儿按用药方案分为观察组34例和对照组33例,分别给予小剂量[1 U/（kg·d）]ACTH和丙戊酸钠糖浆[起始量15 mg/（kg·d）]治疗,治疗2周后观察两组患儿的临床疗效,治疗后2个月行盖塞尔（Gesell）发育量表测试。结果：观察组总有效率为79.41%,高于对照组的45.45%（P<0.05）。Gesell发育量表测试显示,观察组患儿适应性能力好转率为73.53%,高于对照组的30.30%（P<0.05）。结论：小剂量[1 U/（kg·d）]ACTH治疗婴儿痉挛症的疗效明显优于丙戊酸钠糖浆,可供小儿神经科医生治疗婴儿痉挛症参考选择     

托吡酯联合丙戊酸钠治疗难治性癫痫的临床价值

目的:研究托吡酯联合丙戊酸钠治疗难治性癫痫的临床疗效。方法:选取收治的难治性癫痫患者101例,随机分为对照组50例与观察组51例。对照组采用托吡酯治疗,观察组在此基础上添加丙戊酸钠联合治疗。结果:用药后两组患者癫痫发作次数较用药前均有所改善,且观察组改善情况明显优于对照组;两组患者用药后不良反应发生率差异均无统计学意义;观察组治疗总有效率为92.16%,明显高于对照组(72.00%)。结论:托吡酯联合丙戊酸钠对难治性癫痫患者的临床治疗效果非常显著,可有效减少癫痫发作次数,提高治疗效果,且未增加不良反应。     

丙戊酸钠与托吡酯治疗初诊癫痫患者效果对比

目的 比较丙戊酸钠与托吡酯治疗初诊癫痫患者的效果.方法 选择2014年1月至2015年12月收治的90例初诊癫痫患者为研究对象,采用随机数字法将本研究入组患者分为A组和B组,A组给予丙戊酸钠治疗,B组给予托吡酯治疗,观察记录两组患者的临床疗效和药物不良反应.结果 B组治疗总有效率为95.56％,高于A组治疗总有效率,差异有统计学意义(P＜0.05).B组药物不良反应发生率为4.44％,A组药物不良反应发生率为20.00％,差异有统计学意义(P＜0.05).结论 丙戊酸钠与托吡酯治疗初诊癫痫患者都有很好的效果,但是较丙戊酸钠而言,托吡酯效果要好一些,且托吡酯的安全性要高于丙戊酸钠.     

托吡酯联合丙戊酸钠治疗难治性癫痫临床观察

目的：探讨托吡酯联合丙戊酸钠治疗难治性癫痫的临床疗效。方法将我院收治的135例难治性癫痫患者按治疗方法的不同分为治疗组46例,对照组1组45例,对照2组44例。三组均采用抗癫痫药（AED）治疗。治疗组口服托吡酯片、丙戊酸钠片,对照1组仅口服托吡酯片,对照2组仅口服丙戊酸钠片。治疗1个疗程后,比较三组疗效、不良反应及治疗前后发作频率的变化。结果治疗后,治疗组的总有效率均高于对照1组和对照2组,差异有统计学意义;治疗后治疗组的癫痫发作频率均明显低于对照1组和对照2组,差异有统计学意义;三组不良反应发生率比较差异无统计学意义,症状均较轻微,停药后可自行消失。结论托吡酯联合丙戊酸钠治疗难治性癫痫临床疗效良好,结论值得进一步研究。     

丙戊酸钠联合托吡酯在小儿癫痫治疗中的作用分析

目的:探讨丙戊酸钠联合托吡酯在小儿癫痫治疗中的应用效果.方法:将我院2015年1月～2016年6月收治的71例小儿癫痫患者根据随机综合序贯法分为对照组35例和观察组36例,对照组予以丙戊酸钠治疗,观察组在此基础上联合托吡酯干预,观察两组治疗效果.结果:两组总有效率对比差异具有统计学意义(P<0.05);两组不良反应发生率对比差异不具有统计学意义(P>0.05).结论:丙戊酸钠联合托吡酯在小儿癫痫治疗中的应用效果突出,具有疗效好、安全性高等优势,值得临床推广.     

卡马西平、托吡酯与丙戊酸钠治疗脑炎继发癫痫的临床疗效分析

目的分析卡马西平、托吡酯与丙戊酸钠治疗脑炎继发癫痫的临床疗效。方法从本院2016年1月至2017年11月接受的脑炎继发癫痫患者中抽取69例,按照药物不同将其分为A、B、C组,均23例。A组采用卡马西平、B组采用托吡酯、C组采用丙戊酸钠进行治疗,观察三组患者临床疗效和不良反应发生情况。结果 A、B、C三组患者临床疗效差异无统计学意义(P>0.05);但B组托吡酯治疗后不良反应发生率显著低于A组和C组,组间比较结果 P<0.05。结论在脑炎继发癫痫治疗中,采用卡马西平、托吡酯与丙戊酸钠治疗均有显著疗效,三种药物治疗效果差异不大,但应用托吡酯治疗后,患者不良反应发生率较低,安全性更高。     

Newer GABAergic agents for pharmacotherapy of infantile spasms

Infantile spasms is an age-specific epileptic syndrome in infants and young children. Although the exact mechanism is unknown, adrenocorticotrophic hormone (ACTH) has been the mainstay for the therapeutic management of infantile spasms and other developmental epilepsies. Clinical benefits of ACTH in infantile spasms could partially relate to its stimulatory effects on the release of adrenocorticosteroids and neurosteroids. Glucocorticoids, pyridoxine and ketogenic diet therapy have all been used for the treatment of refractory infantile spasms. Recent studies indicate that several newer anticonvulsant agents, which are positive allosteric modulators of GABA(A) receptors, are as effective as ACTH in acutely controlling infantile spasms. The efficacy of agents that enhance GABA-mediated inhibition (such as vigabatrin and benzodiazepines) for rapid and complete abolition of infantile spasms has been demonstrated in several clinical studies. Ganaxolone, a novel neuroactive steroid has, however, demonstrated outstanding efficacy and better tolerability in children with intractable infantile spasms. Zonisamide, topiramate, deoxycorticosterone and neurosteroids are emerging as effective treatment approaches. These new antiepileptic drugs represent a potential nonhormonal approach for infantile spasms, but additional studies are needed to verify their efficacy and tolerability. Future studies will hopefully identify rational antiseizure drugs that not only control infantile spasms but also abrogate its risk on the development of the brain.     

不同剂量促肾上腺皮质激素治疗婴儿痉挛的疗效及不良反应

目的:比较不同剂量促肾上腺皮质激素(ACTH)治疗婴儿痉挛(IS)的疗效及不良反应,为临床提供参考。方法:收集2012年1月至2015年12月在我院住院接受ACTH治疗的60例IS患儿的临床资料,采用随机数表法分为小剂量组和大剂量组各30例。小剂量组的治疗方案:ACTH 1 U/(kg·d)加入60 mL 5%葡萄糖溶液中持续泵入6 h,连用2周,治疗有效,再用2周;治疗无效,加量至25 U/d,再用2周,总疗程4周。大剂量组的治疗方案:ACTH 起始剂量25 U/d,连用2周,治疗有效,再用2周;治疗无效,加量至40 U/d,再用2周,总疗程4周。两组患儿均在ACTH治疗结束后复查脑电图(EEG),并改为口服泼尼松,开始剂量为2 mg/kg,移行减量,总疗程为3个月。结果:大剂量组和小剂量组痉挛发作完全控制率分别为53.33%、46.67%,治疗有效率分别为23.33%、26.67%,两组比较差异均无统计学意义(P均>0.05);但小剂量组高血压、肥胖、易激惹、睡眠障碍发生率均低于大剂量组(P均<0.05)。结论:小剂量ACTH治疗IS疗效与大剂量ACTH相当,但不良反应较少。     

Infantile spasms

Infantile spasms is a catastrophic form of epilepsy found only in infants and young toddlers, with the peak incidence between 4 – 7 months of age. Estimated prevalence is 1 in 2000 – 6000 live births. There are many causes of infantile spasms, including tuberous sclerosis, hypoxic-ischaemic injury, congenital infectious diseases, inborn errors of metabolism, malformations of cortical development, genetic syndromes such as Aicardi’s syndrome and chromosomal abnormalities. A small percentage of patients have idiopathic infantile spasms, with normal growth and development prior to the onset of infantile spasms and no known aetiology. Because of the poor prognosis of infantile spasms, treatment is usually aggressive and immediate, with the hopes of altering the natural history of the disease. The majority of patients with infantile spasms have a poor prognosis with intractable epilepsy, severe developmental delays and/or significant cognitive impairments. Of all patients with infantile spasms, 70 – 90% have mental retardation. Furthermore, 20 – 50% of patients with infantile spasms develop Lennox-Gastaut syndrome with multiple seizure types, cognitive impairments and a markedly abnormal electroencephalogram, arguably one of the most difficult epilepsy syndromes to treat. Infantile spasms are resistant to most of the standard antiepileptic drugs. Adrenocorticotropin hormone (ACTH) or oral steroids result in a significant reduction of seizures, as well as an improvement in the electroencephalogram. Some studies have indicated that infants treated with ACTH within the first month of onset have a more favourable prognosis. Vigabatrin has also been shown to be effective in the treatment, although it is not yet FDA-approved in the US. Valproate has also been used in the treatment of infantile spasms, with an efficacy of ～ 25 – 40%. However, in the very young infant, it does carry a high risk of fatal hepatotoxicity. Surgical resection may be the treatment of choice for those infants with focal cortical dysplasia and intractable infantile spasms. Emerging therapeutic possibilities include topiramate, felbamate, lamotrigine, zonisamide and perhaps levetiracetam. With the advancements in molecular biology, genetics and neuroimaging, there is the hope of novel therapies in the future.     

Infantile spasms

Infantile spasms is a catastrophic form of epilepsy found only in infants and young toddlers, with the peak incidence between 4 - 7 months of age. Estimated prevalence is 1 in 2000 - 6000 live births. There are many causes of infantile spasms, including tuberous sclerosis, hypoxic-ischaemic injury, congenital infectious diseases, inborn errors of metabolism, malformations of cortical development, genetic syndromes such as Aicardi's syndrome and chromosomal abnormalities. A small percentage of patients have idiopathic infantile spasms, with normal growth and development prior to the onset of infantile spasms and no known aetiology. Because of the poor prognosis of infantile spasms, treatment is usually aggressive and immediate, with the hopes of altering the natural history of the disease. The majority of patients with infantile spasms have a poor prognosis with intractable epilepsy, severe developmental delays and/or significant cognitive impairments. Of all patients with infantile spasms, 70 - 90% have mental retardation. Furthermore, 20 - 50% of patients with infantile spasms develop Lennox-Gastaut syndrome with multiple seizure types, cognitive impairments and a markedly abnormal electroencephalogram, arguably one of the most difficult epilepsy syndromes to treat. Infantile spasms are resistant to most of the standard antiepileptic drugs. Adrenocorticotropin hormone (ACTH) or oral steroids result in a significant reduction of seizures, as well as an improvement in the electroencephalogram. Some studies have indicated that infants treated with ACTH within the first month of onset have a more favourable prognosis. Vigabatrin has also been shown to be effective in the treatment, although it is not yet FDA-approved in the US. Valproate has also been used in the treatment of infantile spasms, with an efficacy of approximately 25 - 40%. However, in the very young infant, it does carry a high risk of fatal hepatotoxicity. Surgical resection may be the treatment of choice for those infants with focal cortical dysplasia and intractable infantile spasms. Emerging therapeutic possibilities include topiramate, felbamate, lamotrigine, zonisamide and perhaps levetiracetam. With the advancements in molecular biology, genetics and neuroimaging, there is the hope of novel therapies in the future.     

妥泰与丙戊酸钠对癫痫患者认知功能影响的对比研究

目的:评价妥泰与丙戊酸钠对癫痫患者认知功能的影响。方法:将88例癫痫患者随机均分为妥泰组(治疗组)与丙戊酸钠组(对照组),利用简易精神状态检查量表(MMSE)、事件相关电位P300,分别于治疗前、用药4wk、用药8wk及用药6mo后对患者认知功能进行神经心理学和电生理学评估。结果:治疗组在用药4wk及8wk时与用药前比较,MMSE分值明显下降,P3潜伏期明显延长(P<0·01),而治疗前和用药6mo时各项指标比较无差异;对照组仅在用药8wk时MMSE分值明显下降,P3潜伏期明显延长(P<0·01)。结论:妥泰及丙戊酸钠均可引起癫痫患者认知功能障碍,认知功能障碍多发生于加量期,这种药物引起的认知功能障碍具有可逆性。     

大剂量丙种球蛋白静脉注射治疗小儿重症病毒性脑炎疗效观察

目的观察大剂量丙种球蛋白静脉注射治疗小儿重症病毒性脑炎的临床效果。方法抽取2017年6月-2018年7月邵阳市中心医院收治的小儿重症病毒性脑炎患儿136例,根据丙种球蛋白的治疗剂量分为2组,试验组68例行大剂量丙种球蛋白治疗,对照组68例行小剂量丙种球蛋白治疗。比较2组临床疗效、治疗前后神经功能指标、炎性因子水平及不良反应发生情况。结果试验组总有效率为97.06%,高于对照组的86.76%(χ2=4.847,P<0.05)。治疗后,2组NSE、NGF、MBP、S-100β、CK-BB、IL-1、IL-6、CRP、INF-γ水平均下降(P<0.05),且试验组低于对照组(P<0.01)。2组不良反应发生率比较差异无统计学意义(χ2=0.208,P>0.05)。结论在常规治疗基础上,大剂量丙种球蛋白静脉注射治疗小儿重症病毒性脑炎可减轻患儿炎性反应及神经损害,改善患儿临床症状及体征,且大剂量用药不会增加不良反应发生率,值得临床广泛推广。