苯妥英钠脑病

为了尽早对苯妥英钠（ＤＰＨ）脑病作出诊断以保护癫痫儿童的智力。方法对３３例ＤＰＨ脑病进行了分析，对其中２４例进行了修订韦氏成人智力量表（ＷＡＩＳ－ＲＣ）及韦氏儿童智力量表（ＷＩＳＣ）测验并与性别、年龄、病情相匹配的另外２４例接受卡马西平（ＣＢＺ）治疗的病人及２４例正常者进行了比较。结果全部ＤＰＨ脑病病人均系长期ＤＰＨ治疗和血药浓度偏高的患者，主要临床表现提示进行性恶化的智力衰退，反应迟钝及思睡，癫痫发作可能增多，脑电图（ＥＥＧ）慢波及痫样放电增多，可有脑脊液（ＣＳＦ）蛋白中等增高。神经系统症状体征一般在减药或停药后明显好转或消失。ＷＡＩＳ－ＲＣ及ＷＩＳＣ的分数在ＤＰＨ组明显比ＣＢＺ组及正常组低，Ｐ值分别为＜０．０５及＜０．０１，这说明长期用ＤＰＨ治疗可能对智力有害。结论如果能慎重选用抗癫痫药，防止ＤＰＨ脑病的发生，将是保护癫痫儿童智力的一个较佳手段     

苯妥英钠与癫痫患者的小脑损害

苯妥英钠（ＤＰＨ）自应用于临床以来,一直为多种类型癫痫的首选药物,短期内大量服用或长期服用治疗量的ＤＰＨ,能引起小脑损害甚或小脑萎缩,国内报告不多。我们近几年来收治苯妥英钠（ＤＰＨ）所致小脑损害病人２０例,现报告如下。１临床资料１．１一般资料依病史、临床表现、ＥＥＧ、ＣＴ或ＭＲＩ等诊断为癫痫大发作的病人共２０例,男１５例,女５例,年龄１０－５７岁,病程１－２０年,服用ＤＰＨ时间１月～１５年,用药量０．２－１．０ｇ／ｄ,开始服药至出现小脑损害征时间为 １０ ｄ－ １５年。１．２临床表现全部病例在ＤＰ…     

男性癫痫患者服用抗痫药物后血清性激素水平改变及其临床意义

目的 研究抗痫药物对男性癫痫患者性激素水平的影响。方法 应用放射免疫分析法和免疫放射测定分析法测定应用多种ＡＥＤｓ治疗和未经治疗的男性癫痫患者及健康对照组血清睾酮,游离睾酮,性激素结合球蛋白,雌二醇,间质细胞刺激素,滤泡刺激素的水平。结果未治疗组与正常对照组相比,各项指标均无显著差异。各治疗组与对照组相比,ＦＴ水平均显著降低,ＳＨＢＧ水平显著升高;苯妥英钠治疗组的Ｅ２水平升高;而ＴＴ,ＬＨ,ＦＳ     

癫痫患者单用卡马西平和便用其他抗痉药时卡马西平10,11—环 …

目的 研究癫痫患者单用卡马西平（ＣＢＺ）和合使用其它抗痉药时卡马西平１０，１１－环氧化物（ＣＢＺ－Ｅ）的血浓度。方法 采用市郊和液相色谱法（ＨＰＬＣ）对６７例癫痫患者测定稳态时ＣＢＺ和ＣＢＺ－Ｅ浓度。其中３６例接受单一ＣＢＺ治疗；３１例联合其它抗惊厥剂：苯妥因钠（ＰＨＴ）１４例，丙戊酸钠（ＶＰＡ）１７例结。结果 ＣＢＺ－Ｅ浓度和ＣＢＺ－Ｅ／ＣＢＺ比率在联合治疗组比单一治疗组高，尤其ＣＢＺ＋ＶＰＡ组     

癫痫患者单用卡马西平和合用其他抗痉药时卡马西平10,11-环氧化物的血浓度

目的研究癫痫患者单用卡马西平（ＣＢＺ）和合用其他抗痉药时卡马西平１０，１１－环氧化物（ＣＢＺ－Ｅ）的血浓度。方法采用高效液相色谱法（ＨＰＬＣ）对６７例癫痫患者测定稳态时ＣＢＺ和ＣＢＺ－Ｅ浓度。其中３６例接受单一ＣＢＺ治疗；３１例联合其它抗惊厥剂：苯妥因钠（ＰＨＴ）１４例，丙戊酸钠（ＶＰＡ）１７例。结果ＣＢＺ－Ｅ浓度和ＣＢＺ－Ｅ／ＣＢＺ比率在联合治疗组比单一治疗组高，尤其ＣＢＺ＋ＶＰＡ组比单一治疗组显著增高（Ｐ＜０．０１）。结论在ＣＢＺ血浓度监测中，常规ＣＢＺ－Ｅ浓度测定具有较大临床价值     

卡马西平对癫痫患者染色体畸变率和姐妹染色单体交换频率的影响及与叶酸的

目的 研究卡马西平（ＣＢＺ）的诱变性及其与叶酸的关系,探讨ＣＢＺ致畸及叶酸防止致畸的机制。方法 应用细胞遗传学方法,检测１５例单服ＣＢＺ及１５例ＣＢＺ加叶酸的癫痫患者外周血淋巴细胞染色体畸变率（ＣＡＲ）、姐妹染色单体交换（ＳＣＥ）频率,同时用放免法测定血清叶酸含量,并与未服药癫痫对照组及正常对照组进行比较。结果 单服ＣＢＺ组患者的ＣＡＲ和ＳＣＥ频率较对照组增高,其血清叶酸含量较正常对照组下降;单服ＣＢＺ组患者的ＣＡＲ和ＳＣＥ频率较服ＣＢＺ加叶酸组增高;ＣＢＺ血药浓度与叶酸水平ＣＡＲ及ＳＣＥ之间未发现明显相关性。结论 ＣＢＺ具有ＤＮＡ损伤效应,其损伤效应可能与ＣＢＺ干扰叶酸代谢有关,补充叶酸可以有效防止ＣＢＺ引起的ＤＮＡ损伤。     

男性癫痫病人血清性激素水平的初步观察

用放射免疫法测定５０例成年男性癫痫患者的血清总睾丸酮（ＴＴ）、黄体生成素（ＬＨ）和促卵泡素（ＦＳＨ），并以５０名健康人作对照。结果发现，癫痫组ＴＴ、ＬＨ均较对照组明显升高，频繁癫痫发作、服用苯妥因钠和卡马西平等抗痫药与性激素改变有关。同时对性激素改变的可能机理进行了讨论。对已婚男性癫痫病人有可能或已经发生性功能障碍者，建议选用丙戊酸钠治疗。     

女性急性脑梗死患者内源性性激素和血脂变化的研究

目的 探讨女性急性脑梗死（ＡＣＩ）患者血清性激素水平的变化及其对血脂的影响。方法 应用酶联免疫吸附法、酶比色法和直接测定法检测女性ＡＣＩ患者的血清雌二醇（Ｅ２）、睾酮（Ｔｅ）、Ｅ２／Ｔｅ及血脂含量并与健康人比较。结果 女性ＡＣＩ患者有性激素失衡及血脂异常，Ｅ２、Ｔｅ、ＨＤＬ含量降低，以Ｅ２降低更为明显（Ｐ〈０．０１、Ｐ〈０．０５、Ｐ〈０．０５），而Ｅ２／Ｔｅ无显著性差异（Ｐ〉０．０５），ＬＤＬ、ＴＣ含量较对照组明显升高，均有显著性差异（Ｐ〈０．０１）。结论 性激素水平紊乱是女性急性脑梗死患者的危险因素之一，并影响脂质代谢。     

癫痫发作与长期药物治疗对甲状腺功能的影响(摘要)

为了解抗癫痫药物、中药以及癫痫发作对甲状腺机能的影响。我们利用ＲＩＡ法测定了９４例接受卡马西品（ＣＢＺ）、苯妥因钠（ＰＨＴ）和丙戊酸钠（ＶＰＡ）单一治疗或联合治疗的癫痫病人和接受纯中药治疗的５例癫痫病人血清中ＴＳＨ、ＴＴ３、ＥＴ３、ＴＴ４、ＦＴ４的浓...     

躁狂症血液性激素水平测试分析

躁狂症血液性激素水平测试分析任育麟张巍于东升陈卫国赵金栓刘惠雷祺智王淑平赵竹林指导对２２例男性躁狂症（住院）患者进行血液性激素浓度测定，入院两周以内，症状缓解并符合ＣＣＭＤ—２诊断标准。以符合ＣＣＭＤ—２精神分裂症诊断标准的男性患者２２例为对照，亦于...     

Effects of Carbamazepine Therapy on Serum Sex Hormone Levels in Male Patients with Epilepsy

The effects of carbamazepine (CBZ) therapy and epilepsy on sex hormone plasma levels in male patients with epilepsy were evaluated by measuring the levels of testosterone (T), free testosterone (FT), sex hormone binding globulin (SHBG), estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), and dehydroepiandrosterone sulfate (DHEAS) and by calculating the free androgen index (FAI) in 23 male patients with epilepsy receiving CBZ medication, in 18 untreated male patients with epilepsy, and in 19 healthy age-matched control subjects. No significant differences in the mean T or FT levels were found between the three groups, but the CBZ-treated patients had significantly higher SHBG levels and their FAI values and DHEAS concentrations were lower. The LH, FSH, PRL, or E2 levels in CBZ-treated and untreated male patients with epilepsy did not differ from the controls. CBZ monotherapy does not significantly change the serum balance of sex hormones; however, CBZ clearly affects the serum levels of SHBG and DHEAS.     

Evaluation of thyroid and parathyroid functions in children receiving long-term carbamazepine therapy

We studied serum calcium, phosphorus, alkaline phosphatase (ALP), thyroid hormones (total thyroxine [TT4], free thyroxine [FT4], thyroid-stimulating hormone [TSH]), parathyroid hormone (PH), and osteocalcine levels in children with epilepsy who had been receiving long-term carbamazepine (CBZ) therapy to determine whether there was any effect of CBZ therapy on these hormones. The study included 18 patients with epilepsy receiving CBZ and 16 healthy age-matched controls. The age ranged from 4-18 years (11.26 +/- 3.59 years) and 4.5-17 years (11.16 +/- 3.13 years) in the study and control group, respectively. The duration of CBZ use was between 10 months-5 years (3.12 +/- 1.09 years). When comparing the results we did not find any significant difference in serum calcium, phosphorus, ALP, osteocalcine and TSH and PH levels between the groups (p >.05). However, serum TT4 and FT4 levels were found to be significantly lower in the study group than those of control group (p <.05). However, we observed no clinical signs of hypothyroidism in all subjects. To these findings we suggest that serum thyroid hormone levels should be monitored in children receiving long-term CBZ therapy.     

Brief Communication: EVALUATION OF THYROID AND PARATHYROID FUNCTIONS IN CHILDREN RECEIVING LONG-TERM CARBAMAZEPINE THERAPY

We studied serum calcium, phosphorus, alkaline phosphatase (ALP), thyroid hormones (total thyroxine [TT4], free thyroxine [FT4], thyroid-stimulating hormone [TSH]), parathyroid hormone (PH), and osteocalcine levels in children with epilepsy who had been receiving long-term carbamazepine (CBZ) therapy to determine whether there was any effect of CBZ therapy on these hormones. The study included 18 patients with epilepsy receiving CBZ and 16 healthy age-matched controls. The age ranged from 4-18 years (11.26 &#45 3.59 years) and 4.5-17 years (11.16 &#45 3.13 years) in the study and control group, respectively. The duration of CBZ use was between 10 months-5 years (3.12 &#45 1.09 years). When comparing the results we did not find any significant difference in serum calcium, phosphorus, ALP, osteocalcine and TSH and PH levels between the groups (p >. 05). However, serum TT4 and FT4 levels were found to be significantly lower in the study group than those of control group (p <. 05). However, we observed no clinical signs of hypothyroidism in all subjects. To these findings we suggest that serum thyroid hormone levels should be monitored in children receiving long-term CBZ therapy.­­     

Effects of Carbamazepine on the Hypothalamic-Pituitary-Gonadal Axis in Male Patients with Epilepsy: A Prospective Study

The effects of carbamazepine (CBZ) monotherapy on serum sex hormone levels and on pituitary responsiveness to various stimuli were evaluated in a prospective study with 21 male patients with epilepsy. The serum levels of testosterone (T), free testosterone (FT), sex hormone binding globulin (SHBG), estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), and dehydroepiandrosterone sulfate (DHEAS) were assayed, and the free androgen index (FAI) values were calculated for each patient before and after 2-month CBZ treatment. The pituitary PRL, LH, and FSH responses to luteinizing hormone-releasing hormone (LH-RH), thyrotropin-releasing hormone (TRH), and metoclopramide (MC) were also measured before and after CBZ treatment. The baseline serum hormone and SHBG levels were measured and the FAI values calculated in 16 healthy male control subjects of similar age. The mean E2 level was higher in patients before CBZ treatment than in control subjects, and untreated patients had greater variances for FAI values, PRL levels, and LH levels than control subjects. No other significant differences were found between untreated patients and control subjects. The FAI values and DHEAS levels of patients decreased during 2-month treatment with CBZ. The PRL response to MC was higher after CBZ treatment than before. The baseline levels of other hormones and SHBG, as well as the LH and FSH responses to LH-RH, remained unaltered. The results indicate that during the first 2 months of CBZ treatment the androgen balance in male epileptic patients changes: Serum DHEAS levels and FAI values decrease, although FT levels remain unchanged. The clinical relevance of these hormonal changes is obscure.     

Serum Steroid Hormones and Pituitary Function in Female Epileptic Patients During Carbamazepine Therapy

Ten regularly menstruating women with epilepsy were studied in a 12-month prospective follow-up study to evaluate the short-term effects of carbamazepine (CBZ) on serum sex hormone balance and pituitary function. Thirteen female epilepsy patients receiving long-term CBZ monotherapy (mean medication duration 5.3 years) were also studied. Controls were 17 regularly menstruating healthy volunteers. Untreated patients had higher free testosterone (FT) and luteinizing hormone (LH) serum concentrations than control subjects, whereas the other parameters did not differ between these two groups. However, serum sex hormone binding globulin (SHBG) levels increased and dehydroepiandrosterone sulfate (DHEAS) levels decreased during CBZ treatment. Although calculated free androgen index (FAI) decreased during CBZ therapy, the directly measured FT levels remained unaltered. These changes were found after 2 months and continued after 12 months of CBZ treatment. Moreover, patients with long-term CBZ also had high SHBG levels, low serum DHEAS levels, and low FAI values. Basal LH serum levels decreased during the first year of CBZ treatment and luteinizing hormone-releasing hormone (LH-RH)-stimulated LH concentrations were lower after 2 months of CBZ treatment. Although the serum basal follicle-stimulating hormone (FSH) and prolactin (PRL) levels were unaffected during the first year of CBZ therapy, the LH-RH-stimulated FSH concentrations and metoclopramide (MC)-stimulated PRL concentrations were lower after 12 months of CBZ treatment than before CBZ. Both basal and stimulated gonadotropin and PRL serum levels of long-term CBZ patients were unaffected. No changes were found in estradiol (E2), testosterone (T), or cortisol (C) serum concentrations during short or long-term CBZ treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Antiepileptic Drug Therapy and Sexual Function in Men with Epilepsy

Summary: Purpose: To study the effects of antiepileptic drugs (AEDs) on sex hormone levels and sexual activity in a group of men attending a hospital-based epilepsy clinic. Methods: One hundred eighteen men being treated with AED therapy, 32 with epilepsy but not receiving AEDs, and 34 controls were recruited. All subjects were aged 18–65 years. Blood (20 ml) was removed for hormone assays, after which each subject completed a validated questionnaire [Sexuality Experience Scores (Frenken and Vennix, 1981)] aimed at exploring the individuals' sexual activity and attitudes to sexual morality. Results: Men taking carbamazepine (CBZ) only had significantly higher mean sex hormone-binding globulin (SHBG) levels than the control group. The CBZ group also had a significantly lower mean DHEAS concentration than the control, untreated, and sodium valproate (VPA) monotherapy groups. The phenytoin monotherapy group (PHT) had a significantly higher mean SHBG than both the control and untreated groups, and had a significantly higher mean total testosterone (TT) value than the control untreated, CBZ, and VPA groups, and a significantly lower mean DHEAS than the controls, untreated, and VPA groups. Men receiving more than one AED had significantly higher mean SHBG concentrations compared with control, untreated, and VPA groups. In addition, the poly-therapy group's mean TT was significantly higher than the control and VPA groups, although its mean DHEAS concentration was lower than the control, untreated, and VPA groups. There were no significant differences between the study groups in mean FT, Budrostenedione (AND), or estradiol levels. But the CBZ, PHT, and polytherapy groups had significantly lower mean free and rogen index (FAI) than the controls. The CBZ group had a lower mean FAI than the VPA group. The poly-therapy group had a lower FAI than the untreated group. Sexuality Experience Scores (SES) showed that those men receiving AEDs embraced a stricter sexual morality than the controls and untreated, and expressed greater satisfaction with their marriages than the control and untreated groups. Conclusions: Seizure type did not affect SES scores. Multiple regression showed men who had received further education were less accepting of strict sexual morality.     

Thyroid Function with Antiepileptic Drugs

Serum thyroid hormone balance was assessed in 108 patients receiving chronic antiepileptic drug (AED) therapy. Forty-five patients were receiving carbamazepine (CBZ), 26 phenytoin (PHT), 16 CBZ-PHT, 11 valproate (VPA), and 10 CBZ-VPA. Serum thyroxine (T4) and free thyroxine (FT4) concentrations were low in patient groups receiving CBZ and/or PHT. Serum T4 concentrations were below the normal range in 24 (53.3%) CBZ patients, 11 (42.3%) PHT patients, 12 (75%) CBZ-PHT patients, and in all 10 patients (100%) receiving CBZ-VPA. Furthermore, serum levels of FT4 were below the normal range in 13 (28.9%) CBZ patients, 6 PHT (23.1%) patients, 5 (31.3%) CBZ-PHT patients, and 5 (50%) CBZ-VPA patients. Despite the decreased serum T4 and FT4 levels in these patients, serum basal and stimulated thyrotropin (TSH) concentrations were normal, except for the slightly increased basal TSH in the CBZ-VPA group. In the VPA group, the findings were different from those in other patients: T4 serum levels were unchanged and FT4, T3, and basal TSH levels increased, but stimulated TSH levels did not differ from those of the control group. The decrease in serum thyroid hormone levels during CBZ and/or PHT medication probably is caused by an accelerated hepatic plasma clearance of these hormones due to induction of hepatic microsomal enzyme systems by these AEDs. VPA, an AED with no liver enzyme-inducing properties, does not cause similar changes. The feedback mechanism is not activated, possibly because of a hypothalamic interference by CBZ and PHT.(ABSTRACT TRUNCATED AT 250 WORDS)     

Long-term treatment of children with epilepsy with valproate or carbamazepine may cause subclinical hypothyroidism

PURPOSE: The aim of the study was to evaluate serum thyroid hormone balance in children receiving long-term therapy with carbamazepine (CBZ), valproate (VPA), and phenobarbital (PB). METHODS: We determined serum levels of triiodothyronine (T3), thyroxine (T4), free thyroxine (FT4), thyroxine-binding globulin (TBG), and thyroid-stimulating hormone (TSH) in 148 healthy children and 141 children with epilepsy who had been receiving CBZ (61 patients), VPA (51 patients), or PB (29 patients) for 12-161 months. In view of TSH values, three categories of subclinical hypothyroidism were considered: I, TSH greater than the control-group mean + 2 SD (4.37 mIU/L in our study) and <6 mIU/L; II, TSH between 6 and 12 mIU/L; and III, TSH >12 mIU/L. RESULTS: In all treated groups, mean T4 and FT4 levels were lower than in the control group, whereas the CBZ- and VPA-treated children additionally showed reduced mean T3 and TBG levels and increased mean TSH levels. In the group receiving CBZ, 8.2% had TSH values higher than the normal-range maximum, by comparison with only 3.6% of healthy children. The increase in TSH levels was particularly marked in VPA-treated children, accounting for 26% of patients with subclinical hypothyroidism. CONCLUSIONS: Our results, in contrast to previous reports, suggest that CBZ and particularly VPA may induce subclinical hypothyroidism. This suggests a need for careful monitoring of TSH levels in children receiving CBZ or VPA.     

Menstrual Disorders in Women with Epilepsy Receiving Carbamazepine

Summary: We measured concentrations of serum sex hormones and sex hormone binding globulin (SHBG) in relation to regularity of the menstrual cycles in 8 women before carbamazepine (CBZ) treatment was initiated and after 1 and 5 years of CBZ therapy. In addition, we evaluated menstrual cycle regularity and related endocrine changes in 56 women receiving CBZ treatment for >5 years. Serum SHBG levels increased, and serum concentrations of 17β-estradiol (estradiol) and estradiol/SHBG ratio decreased during CBZ treatment. Two of the 8 patients (25%) in the prospective study group developed menstrual irregularities during the first 5 years of therapy. In the cross-sectional study group of patients treated with CBZ for >5 years, the frequency of menstrual disturbances was also 25.0% (14 of 56 patients). Concentrations of serum sex hormones and SHBG were measured in 13 women with menstrual disorders and in 11 randomly selected women with regular cycles. In most cases, menstrual disorders were associated with increased serum SHBG and decreased serum estradiol levels and low estradiol/SHBG ratio. Long-term CBZ treatment results in increased serum SHBG levels and decreased estradiol effect, which correlate with the frequency of menstrual disorders in CBZ-treated women with epilepsy.