拉莫三嗪单药对部分性发作癫痫儿童脑电活动的影响

目的探讨拉莫三嗪单药对部分性发作癫痫患儿脑电活动的影响。方法首次确断为部分性发作癫痫患儿41例加用拉莫三嗪治疗12个月,治疗前后分别行24h动态脑电图检测,观察脑电图中0波和痫样放电的情况。结果拉莫三嗪单药治疗41例患儿12个月,脑电图中0波和痫样放电较治疗前明显减少。结论拉莫三嗪可明显改善部分性发作癫痫患儿脑电图变化,减少部分性发作癫痫患儿癫痫发作,改善癫痫患儿的认知功能。     

拉莫三嗪治疗各种类型癫痫患儿的疗效分析

目的观察拉莫三嗪对各种类型癫痫患儿的疗效分析。方法对139例癫痫患儿进行拉莫三嗪治疗,观察其疗效以及安全性。结果拉莫三嗪对各种癫痫均有效,总有效率86.1%,控制率52.3%,不良反应发生率低。结论拉莫三嗪作为一种新型的抗癫痫药,对各类癫痫均取得了很好的效果。     

加用拉莫三嗪治疗成人难治性部分性癫痫的疗效观察

目的:观察加用拉莫三嗪治疗难治性部分性癫痫的效果。方法:连续性收集2007-2010年在我院就诊的62例难治性部分性癫痫患者,均为连续正规治疗2年以上仍频繁发作的患者,原服用抗癫痫药药量不变,加用拉莫三嗪口服。采用开放性试验的方法观察6个月,评价拉莫三嗪对难治性部分性癫痫的发作控制率、脑电图改善情况、不良反应和安全性。结果:加用拉莫三嗪治疗难治性部分性癫痫,有效率82.3%,24.2%的患者发作完全控制。治疗前后的肝、肾、血、尿等实验室检查及心电图无明显变化,偶有患者出现轻度副作用,但不影响结果。结论:加用拉莫三嗪治疗难治性部分性癫痫疗效确切,副作用轻。     

拉莫三嗪添加-替换治疗对丙戊酸无效的癫痫患者的疗效观察

目的探讨拉莫三嗪添加-替换治疗对丙戊酸无效的癫痫患者的临床疗效。方法选取2010年1月-2014年1月期间收治的丙戊酸治疗无效的28例癫痫患者为研究对象,根据其临床资料进行回顾性分析,观察拉莫三嗪添加-替换治疗曾用丙戊酸治疗无效的癫痫患者的临床疗效。结果 25例患者完成联合用药阶段,其中完全控制为15例,有效为8例,总有效率为92.0%;17例患者转换为拉莫三嗪单药治疗,其中完全控制为9例,有效为2例,总有效率为64.7%,拉莫三嗪单药与联合用药阶段的完全控制率、总有效率比较,差异具有统计学意义（P〈0.05）。结论拉莫三嗪联合丙戊酸治疗对丙戊酸无效的癫痫患者优于单用拉莫三嗪的治疗效果,患者产生的不良反应比较少,值得在临床实践中广泛的应用和推广。     

拉莫三嗪单药治疗癫痫的临床疗效和安全性

目的:探讨在治疗癫痫的过程中应用拉莫三嗪单药的临床疗效和安全性.方法:随机选取我院2015年2月～2016年2月收治的80例确诊为癫痫的患者作为研究对象,平均分为两组.对对照组给予丙戊酸钠进行治疗,对观察组给予拉莫三嗪单药进行治疗.治疗期间将临床疗效及不良反应发生率进行比较分析.结果:给予拉莫三嗪单药的观察组,临床疗效高达95％明显高于试验组的80％,不良反应发生率更低.结论:拉莫三嗪单药应用于癫痫治疗,能有效改善癫痫发作,对比传统的抗癫痫药物丙戊酸钠临床效果更好,且不良反应更少,从而减轻患者、家属的负担,值得推广.     

影响拉莫三嗪治疗儿童癫痫疗效的相关因素分析

目的:分析拉莫三嗪(LTG)治疗儿童癫痫的疗效及影响疗效的因素。方法:选取2012年5月至2014年11月于北京大学第一医院小儿神经科门诊就诊及病房住院的癫痫患儿为研究对象,回顾性分析应用拉莫三嗪治疗的临床资料,进行疗效评价;分析性别、起病年龄、起病前发育情况、发作类型、加用拉莫三嗪时的病程、单药/添加治疗、血药浓度等对拉莫三嗪疗效的影响。结果:185例患儿纳入研究,无发作率16.2%,有效率38.9%,无效率44.9%,总有效率55.1%;单因素分析显示,起病前发育情况(P=0.002)及发作形式(P=0.072) 与拉莫三嗪疗效相关;经多因素分析,仅起病前发育情况与疗效相关[OR=2.67,95% CI(1.39,5.10),P=0.003]。结论:拉莫三嗪治疗儿童癫痫有一定的疗效,患儿起病前发育情况与拉莫三嗪疗效相关。     

丙戊酸联合拉莫三嗪治疗癫痫的疗效及安全性研究

目的：分析丙戊酸联合拉莫三嗪治疗癫痫的疗效及安全性。方法纳入2012年11月至2014年11月我院收治的128例癫痫患者,根据其年龄分为儿童组（30例）及成人组（98例）,每组随机挑选,将癫痫患者均分为实验组及对照组,每组64例,两组临床资料无统计学差异,具有可比性（P＞0.05）。对照组仅服用拉莫三嗪,实验组丙戊酸联合拉莫三嗪治疗。观察治疗后3、6、9个月时,每组50%有效率、75%有效率、发作完全控制率,观察联合用药组儿童及成人的各类癫痫发作结局,并同时记录服药过程中的不良反应。结果治疗后3个月,实验组50%有效率、75%有效率及发作完全控制率与对照组相比,差异均有统计学意义（χ2=7.852、7.802、14.565,P＜0.05）;治疗后6个月,实验组50%有效率、75%有效率及发作完全控制率与对照组相比,差异均有统计学意义（χ2=8.553、7.814、16.045, P＜0.05）;治疗后9个月,实验组50%有效率、75%有效率及发作完全控制率与对照组相比,差异均有统计学意义（χ2=8.605、3.908、15.661,P＜0.05）;联合用药治疗儿童组及成人组发作完全控制率+发作改善率,在CPS+SGTCS型均显著低于SPS+GS型（P＜0.05）。结论丙戊酸联合拉莫三嗪联合治疗SPS及GS癫痫疗效优于CPS及SGTCS,且安全可靠,值得推广应用。     

丙戊酸钠联合拉莫三嗪治疗不同类型儿童癫痫的临床观察

目的 探讨不同类型儿童癫痫患者采取丙戊酸钠联合拉莫三嗪治疗的临床效果.方法 选取小儿难治性癫痫患者107例,根据癫痫分型进行分组,其中部分发作型（PS）44例,部分发作继发全面发作型（SGS）31例,全面发作型（GS）24例,Lennox Gastaut综合征（LGS）8例,均给予丙戊酸钠联合拉莫三嗪口服治疗,观察治疗效果.结果 SGS患者临床完全控制率最高,而LGS型患者临床控制率最低;GS患者临床恶化率最高;LGS患者总有效率最高,其次是SGS患者,PS和GS患者有效率相对较低.经过治疗,各种类型癫痫患者月平均发作频次较治疗前均有明显降低（P＜0.05）.14例（13.08％）患儿出现不良反应,未予处理,自行缓解.结论 丙戊酸钠联合拉莫三嗪治疗不同类型的小儿难治性癫痫均可以取得较好的效果,且安全性良好.     

青少年肌阵挛性癫痫药物治疗临床分析

目的探讨青少年肌阵挛性癫痫(JME)的临床治疗优选方案。方法 60例JME患者随机分为口服丙戊酸钠(VPA)组、拉莫三嗪(LTG)组、丙戊酸钠加拉莫三嗪(VPA+LTG)组,每组20例。总结其发作类型及治疗方案特点。结果 VPA组对肌阵挛、全身强直-阵挛发作(GTCS)及失神的控制率分别为75.0%、76.5%、66.7%,LTG组分别为40.0%、68.8%、25.0%,且有3例明显肌阵挛发作加重,VPA+LTG组分别为95.0%、94.1%、60.0%,不同发作类型的控制率存在差别,三组比较,差异具有统计学意义(P<0.05)。结论 JME的治疗主要依据其临床发作特点选择治疗方案,单药治疗首选丙戊酸钠,其次可选拉莫三嗪,联合药物治疗可有明显的优于单药治疗的效果。     

拉莫三嗪单药添加-替换治疗失神癫痫18例临床观察

目的观察拉莫三嗪(LTG)单药治疗失神癫痫(包括儿童失神癫痫和少年失神癫痫)的疗效及安全性。方法对18例失神癫痫患儿采用添加-替换LTG治疗开放性自身对照临床试验。结果18例患儿中,15例发作频度减少≥50%(83.3%),12例发作完全消失,显示单药LTG治疗失神癫痫疗效较佳;副作用小,仅5例有头痛、头晕、嗜睡等副作用,可自然消失或在减量后消失,未发现皮疹等过敏反应。结论LTG是一有效抗癫痫药,特别适用于小儿失神癫痫。     

奥卡西平单药治疗2岁以下部分性发作癫痫患儿的临床观察

目的：探讨奥卡西平口服混悬液单药治疗2岁以下婴幼儿部分性发作癫痫的临床疗效和安全性。方法：收集2岁以下婴幼儿部分性发作癫痫患儿52例,给予奥卡西平口服混悬液单药治疗,起始量为8—10mg／（kg·d）,渐加量至20～40mg／（kg·d）,随访6～18个月,进行自身对照开放性研究,观察其疗效及安全性。结果：应用奥卡西平口服混悬液治疗后,有效率及控制率分别为94．2％、84．6％,8例（15．4％）患儿发生腹泻、呕吐、纳差、皮疹等不良反应。结论：奥卡西平口服混悬液治疗婴幼儿部分性发作癫痫疗效显著,临床应用方便,安全性好,不良反应较少,值得临床推广应用。     

丙戊酸镁缓释片联合拉莫三嗪治疗癫痫强直性阵挛发作的疗效评估

目的：研究对癫痫强直性阵挛发作患者采用丙戊酸镁缓释片、拉莫三嗪联合治疗的临床效果。方法选取2O1O 年3月-2O13年3月本院收治的癫痫强直性阵挛发作患者128例,将患者分为对照组和观察组。对照组给予单一用药方案治疗,观察组给予联合用药方案治疗。结果治疗后观察组患者的临床有效率高于对照组,差异有统计学意义（P 〈 O. O5）。两组患者不良反应比较,差异无统计学意义（P 〉 O. O5）。结论丙戊酸镁缓释片联合拉莫三嗪是治疗癫痫强直性阵挛发作的有效药物,可显著改善患者的临床症状,不良反应少,安全性高,值得临床推广。     

拉莫三嗪联合丙戊酸钠治疗外伤性癫癎复发疗效观察

目的 探讨丙戊酸钠治疗外伤性癫癎复发后,比较添加卡马西平或拉莫三嗪联合治疗外伤性癫癎效果.方法　采用开放性试验的方法对131例丙戊酸钠治疗外伤性癫癎复发患者,进行卡马西平或拉莫三嗪联合丙戊酸钠治疗,以治疗前3个月癫癎发作频度为对照,对治疗6个月后的疗效、不良反应及安全性进行自身对比观察.结果　应用卡马西平或拉莫三嗪联合丙戊酸钠治疗6个月后,患者发作频率均较用药前明显减少;发作频率减少≥50％的患者分别为72.6％和91.3％,差异有统计学意义(P＜0.01);卡马西平联合丙戊酸钠不良反应的发生率为37.1％,拉莫三嗪联合丙戊酸钠不良反应的发生率为8.7％.结论　拉莫三嗪联合丙戊酸钠治疗外伤性癫癎复发疗效确切,不良反应轻微.     

Gabapentin and lamotrigine: novel antiepileptic drugs.

The pharmacokinetics, efficacy, and adverse effects of gabapentin and lamotrigine, two new antiepileptic drugs (AEDs), are reviewed. Gabapentin and lamotrigine are promising advances in the treatment of epilepsy, which has not been satisfactorily controlled by available agents in 25-41% of patients. Gabapentin is chemically similar to gamma-aminobutyric acid, but it is able to pass into the central nervous system. It is effective for the treatment of partial-onset seizures that are refractory to other AEDs. It has no known drug-drug interactions and a relatively benign adverse effect profile, but its short half-life necessitates at least thrice-daily dosing. Lamotrigine is structurally unrelated to the other available AEDs. Its role is currently limited to add-on therapy in patients with partial seizures, with or without secondary generalization, that are resistant to current treatment. The efficacy of lamotrigine in patients with primary generalized tonic-clonic seizures, absence seizures, and Lennox-Gastaut syndrome remains to be validated. The adverse effect profile also remains to be determined. A rash may appear in up to 5% of patients, possibly necessitating discontinuation of the drug. Although lamotrigine does not seem to affect the pharmacokinetics of the other AEDs, the other AEDs affect lamotrigine pharmacokinetics. Lamotrigine can be given once or twice daily. Gabapentin and lamotrigine may be useful in treating patients whose epilepsy is not controlled by other available AEDs; however, further research is needed to confirm their roles in epilepsy treatment.     

Clinical experience with lamotrigine monotherapy in adults with newly diagnosed epilepsy: a review of published randomised clinical trials

OBJECTIVES: This paper aimed to provide an overview from published randomised clinical trials of the efficacy and tolerability of lamotrigine monotherapy compared with carbamazepine and phenytoin when initiated in adult patients with newly diagnosed epilepsy. DESIGN: The review included two double-blind, randomised trials of lamotrigine monotherapy compared with carbamazepine and phenytoin, respectively, and one open randomised trial comparing lamotrigine with carbamazepine. The results of the three trials were pooled for comparison of tolerability. SETTING: Multicentre in Europe. PATIENTS: Adult patients (>12 years of age) with newly diagnosed partial seizures (with or without secondary generalisation) and primary generalised tonic-clonic seizures (n = 443 patients on lamotrigine, n = 246 on carbamazepine, n = 95 on phenytoin). RESULTS: Comparable efficacy was demonstrated between lamotrigine and both carbamazepine or phenytoin. The time to withdrawal survival analysis supported a significant difference in favour of lamotrigine [hazard ratio 1.57 (95% CI 1.07 to 2.31)] in the double-blind trial. Overall, twice the proportion of patients withdrew from carbamazepine or phenytoin because of adverse events (19.1 and 18.9%, respectively) compared with lamotrigine (9.5%). Lamotrigine was particularly well tolerated with regard to adverse effects affecting the central nervous system. Rash was the most common adverse event necessitating discontinuation of each drug, the rates being very similar across treatment groups (6.1% on lamotrigine, 8.9% on carbamazepine, 5.3% on phenytoin). The rate of rash resulting in withdrawal of lamotrigine was clearly related to the dose escalation employed in the different trials during the first month of therapy. CONCLUSIONS: Lamotrigine is an effective monotherapy treatment for adult patients with newly diagnosed epilepsy, and is better tolerated than either carbamazepine or phenytoin monotherapy. The incidence of rash requiring withdrawal of lamotrigine is related to dose escalation (2.2% of patients withdrawing when the recommended escalation was followed).     

Lamotrigine. A review of its use in childhood epilepsy

Lamotrigine is an antiepileptic agent that blocks use-dependent voltage-sensitive sodium channels, thereby preventing excitatory neurotransmitter release. However, this mechanism does not explain the broad range of clinical efficacy of this agent. In noncomparative trials, adjunctive lamotrigine (< or = 15 mg/kg/day) improved seizure control in children and adolescents with various refractory seizure types, with about 29 to 90% of patients showing a > or = 50% reduction in seizure frequency after > or = 3 months' treatment. Lamotrigine was particularly effective in generalised seizures, especially absence seizures and those related to the Lennox-Gastaut syndrome. In one placebo-controlled study, 33% of children and young adults (aged 3 to 25 years) with refractory Lennox-Gastaut syndrome had a reduction in seizure frequency of > or = 50% after 16 weeks of adjunctive lamotrigine treatment, compared with 16% of placebo recipients (p = 0.01). Significant reductions in seizure frequency when compared with placebo were also observed in patients with refractory generalised and partial seizures. The use of lamotrigine has also been associated with beneficial effects on cognition and behaviour. Adverse events associated with lamotrigine are primarily neurological, gastrointestinal and dermatological and are typically mild or moderate and transient with the exception of a potentially serious rash. Maculopapular or erythematous skin rash occurred in approximately 12% of paediatric patients (aged < 16 years) treated with lamotrigine and was the most common reason for treatment discontinuation. More severe forms of rash, including Stevens-Johnson syndrome, occasionally occurred, with a 3-fold higher incidence in children (approximately 1%) than adults (approximately 0.3%). However, lamotrigine treatment in paediatric trials was generally given at higher initial doses and faster dose escalations than recently revised recommendations. These factors, as well as concomitant use of valproic acid (valproate sodium), are associated with an increased risk of rash. CONCLUSION: Although published clinical evidence is still limited in paediatric populations, lamotrigine is an effective and generally well tolerated broad-spectrum agent for adjunctive treatment of refractory seizures in children, most notably in those with Lennox-Gastaut syndrome. Results of direct comparisons with other antiepileptic agents are needed to determine more clearly the place of lamotrigine, particularly relative to newer agents, in the treatment of childhood epilepsy. The potential for serious rash in recipients of lamotrigine should also be kept in mind. Nonetheless, lamotrigine is a welcome addition to the available treatments for refractory childhood epilepsy, particularly Lennox-Gastaut syndrome.     

奥卡西平添加治疗成人难治性癫痫部分性发作的疗效分析

目的：探讨临床采用奥卡西平添加对于成人难治性癫痫部分性发作患者的治疗效果以及安全性。方法选择2009年2月到2012年6月期间收治的76例难治性癫痫部分发作患者作为研究对象,患者保持以往抗癫痫药物不变,在此基础上加用奥卡西平进行治疗,观察期为1年,采用自身对照开放性研究,观察该治疗方案的治疗效果、保留率、不良反应发生情况以及安全性。结果69例患者经过12月随访,保留率为90．79％,治疗总有效率为44．93％（31例）,与治疗前比较,总发生频率降低42．11％（χ2＝36．810, P＝0．000）,单纯部分发作癫痫（SPS）发生减少42．32％（χ2＝7．864,P＝0．046）,复杂性部分发作癫痫（CPS）发生减少39．67％（χ2＝7．872,P＝0．047）,部分性发作继全面性发作癫痫（SGS）发生减少41．96％（χ2＝7.869,P＝0．047）,其中34例（49．28％）患者出现嗜睡5例（14．71％）、眩晕3例（8．82％）、头痛13例（38.26％）、恶心6例（17．65％）、注意力不集中2例（5．88％）、疲乏5例（14．71％）等不良反应,均出现在加量期,均为轻中度,不进行特殊的临床处理,停药后自行缓解或者消退。结论奥卡西平对于成人难治性癫痫部分发作治疗效果显著,安全性、耐受性较好,值得在临床上广泛的推广和应用。