免疫调节剂辅助治疗难治性癫痫患儿临床疗效及免疫功能观察

目的 研究免疫球蛋白、胸腺肽等免疫调节剂辅助治疗难治性癫痫的临床疗效，观察免疫调节剂对难治性癫痫患儿免疫功能的影响，探讨通过免疫调控辅助治疗难治性癫痫的可行性。方法 70例难治性癫痫患儿随机分为三组，30例仅采用抗癫痫药物治疗（对照组），20例抗癫痫药物加免疫球蛋白治疗（免疫球蛋白组），20例抗癫痫药物加胸腺肽治疗（胸腺肽组）。血清IgA、IgG、IgM、C3测定采用单向免疫扩散法。CD3、CD4、CD8等T细胞亚群测定采用桥联酶标法。结果 免疫球蛋白组（55．00％）、胸腺肽组（52．50％）癫痫控制总有效率（Ⅰ满意＋Ⅱ显著改善＋Ⅲ良好）皆显著高于对照组（8.33％）。对照组治疗前后比较：患儿IgA、IgG、IgM、C3、CD3、CD4、CD8、CD4／CD8等各项免疫指标差异皆无显著性意义。免疫球蛋白组、胸腺肽组治疗前后比较：患儿IgA、IgG升高，IgM、C3无明显差异，CD3、CD4、CD4／CD8升高，CD8降低。结论 免疫球蛋白、胸腺肽使难治性癫痫患儿癫痫发作控制总有效率显著提高：免疫球蛋白、胸腺肽能够显著改善难治性癫痫患儿免疫功能。     

维生素E添加治疗儿童难治性癫痫的实验研究

目的:为研究抗氧化剂维生素E在儿童难治性癫痫中的治疗作用,将维生素E作为添加剂治疗了35例儿童难治性癫痫患者。方法:实验分两步进行,先行3个月抗癫痫药(AED)基础治疗,然后加用维生素E治疗3个月,观察痫性发作频率的变化,同时检测血清中超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)、谷胱甘肽(GSH)、脂质过氧化物(LPO)的变化。结果:基础治疗期间痫性发作频率为16.29±7.16与维生素E添加治疗期间10.06±3.86相比差异有显著意义(P<0.001),添加维生素E后SOD、GSH-PX均有回升,LPO有所下降,与添加前比较差异有显著性,但GSH变化不大,在研究过程中未见明显不良反应发生。结论:维生素E添加治疗儿童难治性癫痫有效且安全,其机理可能与自由基参与癫痫的发病过程有关,也可能与维生素E的细胞保护作用有关。     

生酮饮食联合抗癫痫药物对难治性癫痫的疗效评价

目的评价生酮饮食(KD)联合抗癫痫药物对难治性癫痫的疗效。方法对77例难治性癫痫患者在原有药物不变的基础上添加KD治疗3个月。观察癫痫临床发作频率的改变,判断疗效。比较有效组和无效组患者的临床资料,分析影响KD疗效的因素。结果在KD治疗后,完全控制16例(20.8%),显著有效14例(18.2%),有效12例(15.6%),无效35例(45.5%);KD添加治疗的总有效率为54.5%,保留率为76.6%。KD添加治疗无效组合用药物种类、智能障碍比例及睡眠障碍比例均明显高于有效组;而痉挛发作比例则明显低于有效组(均P0.05)。结论 KD联合抗癫痫药物治疗难治性癫痫总体有效,尤其是痉挛发作类;对伴有智能障碍、睡眠障碍及合用药物种类偏多者疗效欠佳。     

脑立体定向手术治疗难治性癫痫34例临床分析

目的探讨计算机辅助立体定向射频毁损手术对难治性癫痂的适应征选择、手术方式、术后并发症及治疗效果。方法利用计算机辅助手术计划系统和CT／MR图像融合技术,应用射频热凝多靶点毁损术对34例难治性癫痫病人进行手术治疗,积极防治术后并发症和继续抗癫痫药物治疗,于术后1a采用国内癫痫疗效评定标准评定疗效。结果术后并发肢体轻瘫6例,记忆障碍2例,均在4周内恢复。手术治疗1a后,21例癫痼症状基本控制,9例癫痫未再发作,4例发作次数减少50％以上;显著改善8例,良好4例,较差1例,无改善0例。结论计算机辅助立体定向多靶点射频热凝毁损手术治疗难治性癫痫是一种安全有效的治疗方法。     

抗癫痫药联合B族维生素对脑卒中后迟发性癫痫的作用

目的探讨抗癫痫药物联合B族维生素治疗脑卒中后迟发性癫痫的临床疗效。方法选取脑卒中后迟发性癫痫患者50例,采用随机数字表分为对照组和观察组,对照组予以抗癫痫药物治疗,观察组在对照组基础上予以维生素B12(甲钴胺)治疗,评估2组临床疗效、临床症状评分及不良反应,记录2组治疗前后发病频率。结果观察组有效率88.0%,显著高于对照组的64.0%(P0.05);观察组治疗后症状评分及发作频率分别为(2.85±1.09)分、(3.05±2.61)次/a,均显著低于对照组(P0.05)。结论抗癫痫药物联合甲钴胺治疗脑卒中后迟发性癫痫疗效确切,可减少发作频率。     

维生素E辅助治疗癫痫患者的临床疗效及作用机制探讨

目的：探讨维生素E辅助治疗癫痫的临床疗效，并分析其作用机制。方法选择我院神经内科收治的140例癫痫患者作为研究对象，其中观察组70例采用常规癫痫药物联合维生素E治疗，对照组70例采用常规癫痫药物治疗，比较2组临床疗效，并分析其作用机制。结果观察组总有效率82.86％，明显高于对照组，差异有统计学意义（ P＜0.05）；观察组血浆T-Aoc水平较对照组明显增加，而MDA水平较对照组明显降低，差异均有统计学意义（P＜0.05）。结论维生素E辅助治疗癫痫患者具有显著疗效，改善体内自由基水平，保护脑组织，阻止神经元放电，值得临床推广和应用。     

拉考沙胺在儿童难治性癫痫添加治疗的临床效果观察

目的观察考拉沙胺(Lacosamide,LCM)对儿童难治性癫痫添加治疗中的临床疗效。方法收集2019年3月-2019年7月河南省人民医院儿科收治并使用LCM添加治疗的难治性癫痫患儿41例,男21例,女20例,年龄4.6~15.5岁,平均(7.21±3.06)岁。首发年龄0.1~11.0岁,平均(2.82±2.43)岁;病程在0.6~10.0年,平均(4.49±2.34)年。通过自身空白对照研究,口服LCM 6个月,并进行随访,对比观察使用LCM前后的疗效。结果通过空白自身对照,添加LCM药物后,随访时间3、6个月患儿癫痫发作频率显著减少,差异具有统计学意义(P<0.05),且LCM能有效改善患儿精神状态,但对局灶性难治性癫痫发作与全面性难治性癫痫发作改善作用的差异无统计学意义(P>0.05)。结论LCM作为第三代新型抗癫痫药物,添加治疗儿童难治性癫痫能有效地改善癫痫发作频率,并对改善患儿的精神状态具有一定作用。     

西比灵辅助治疗癫痫的疗效及其对脑脊液钙含量的影响

目的 观察西比灵辅助治疗癫痫的疗效，及对脑脊液钙含量的影响。方法 将64例癫痫病人随机分为西比灵组及对照组32例。两组按不 发作类型分别应用抗癫痫药物治疗。西比灵组加西比灵每晚5mg，2周内加至每晚10mg，连服3个月。观察治疗前，后癫痫发作频率及癫痫发作后3小时，72小时脑脊液Ca^2 含量。结果 西比灵组总有效率有75％，对照组为50％，两组有显著差异（P＜0．05）。癫痫发作后3小时脑脊液Ca^2 含量明显低于健康组（P＜0．01），发作后72小时西比灵组已恢复到健康组水平（P＞0．05），而对照组仍低于健康组（P＜0．01）。结论 西比灵配合抗癫痫药物治疗，能减少癫痫患者的发作频率，并能迅速恢复癫痫病人脑脊液Ca^2 浓度。     

儿童难治性癫痫的长期治疗

治疗癫痫患者的最终目标是摆脱癫痫发作,但有些癫痫患儿可能需要终身治疗,尤其是难治性癫痫患儿更加现实的目标是降低具有致残性发作类型的发作频率。长期发作会影响患儿社会活动、心理、认知等功能,因此对这些患儿的长期管理需要儿科和神经内科医师,以及社会工作者联合给予终身关爱。在治疗过程中,临床医师应定期评价患儿病情,注意预防和控制抗癫痫药物的不良反应,监测抗癫痼药物相关不良事件;为难治性癫痫患儿选择最佳治疗方案,在收益与风险之间达到平衡,提高患儿生活质量。     

生酮饮食疗法对难治性癫痫患者发作频率、血清单胺类神经递质水平的影响

目的探究生酮饮食结合抗癫痫药物对难治性癫痫患者发作频率、血清单胺类神经递质的影响。方法将2016年1月至2018年2月我院神经内科收治的72例难治性癫痫患儿纳入研究,所有患儿均在原有抗癫痫药物基础上进行至少3个月的生酮饮食治疗,于治疗后3、6、12个月时统计癫痫发作频率,复查脑电图评价脑部放电控制情况;于治疗6个月时采用韦氏儿童智力量表对患儿治疗前后的认知功能进行评价,测定事件相关电位P300及血清去甲肾上腺素(NE)、多巴胺(DA)、5-羟色胺(5-HT)水平。结果所有患儿均接受随访,治疗维持3、6、12个月的患者分别为72例、60例、38例。生酮饮食治疗3、6、12个月时临床发作控制有效率分别为40.3%、50%、55.3%,完全控制发作率分别为2.8%、18.3%、21.1%;脑电波减少有效率分别为50%、68.3%、76.3%;与治疗前比较,治疗6个月时患儿言语智商、操作智商、全量表智商得分未见显著性改变(P 0.05);与治疗前比较,治疗6个月时患儿N_2PL显著降低,P3波幅及血清NE、DA、5-HT等神经递质水平显著升高(P 0.05)。结论总体上生酮饮食结合抗癫痫药物治疗难治性癫痫有效,不仅可降低癫痫发作次数,也可一定程度改善患儿认知功能,其机制可能与其对神经递质的调控相关。     

Prednisone therapy in pediatric epilepsy

Steroids are often an effective treatment for the West's syndrome. There have been few reports of steroid use in children with epilepsy outside the first year of life. I report my experience with prednisone for the treatment of older children with intractable epilepsy. Twenty-eight children (17 boys, 11 girls) aged 18 months to 10 years with intractable epilepsy were studied. Prednisone 1 mg/kg/day for 12 weeks (6 weeks daily and 6 weeks alternate therapy) was prescribed in addition to their regular antiepileptic medications. The parents kept seizure diaries, and the patients were regularly assessed for seizure frequency and side effects. The follow-up period was for 1 to 5 years. Thirteen patients (46%) became seizure free on prednisone and another 18 (40%) had a significant decrease in seizure frequency. Five patients (19%) had no change in seizure frequency. The best outcomes were seen in the absence group in which six out of seven patients became seizure free and in the Lennox-Gastaut syndrome group in which seven out of 10 became seizure free. Side effects were uncommon and included weight gain in five patients and aggression in four patients. Prednisone therapy is a safe and effective adjunctive treatment for epilepsy. It should be considered as an alternative treatment for older children with intractable generalized epilepsy who have failed conventional antiepileptic therapy.     

Efficacy and tolerability of adjunctive therapy with zonisamide in childhood intractable epilepsy

Purpose: This study investigated the efficacy and safety of zonisamide (ZNS) adjunctive therapy in children with intractable epilepsy to existing antiepileptic drugs (AEDs). Methods: A clinical retrospective study was performed from 2003 to 2005 at two tertiary epilepsy centers. We reviewed the data from 163 children (107 boys and 56 girls) who experienced more than four seizures per month, whose seizures were intractable to an initial 2 or more AEDs, and could be followed up for at least 6 months after ZNS adjunctive therapy initiation. Efficacy was estimated by seizure reduction rate according to seizure types including infantile spasms, and adverse events were also measured. Results: Seventy-nine patients (48.5%) out of 163 patients experienced a reduction in seizure frequency of more than 50%, and 25 patients (15.3%) became seizure-free. The rate of seizure reduction greater than 50% in children with partial seizures was 40.5% (17/42) and in children with generalized seizures was 51.2% (62/121). Of 36 patients who manifested mainly myoclonic seizures, 20 patients (55.6%) showed a seizure reduction of more than 50% and 9 patients (25.0%) were seizure-free. Mean maintenance dosage of drug was 8.2 mg/kg/day (range 5.0-16.0 mg/kg/day). Adverse events were documented in 15 children (9.2%), including somnolence (8 patients), fatigue, and anorexia, but all were transient and successfully managed. One patient discontinued ZNS therapy due to acute pancreatitis. Conclusion: ZNS adjunctive therapy is an effective and safe treatment in various childhood intractable epilepsy.     

Steroids in intractable childhood epilepsy: clinical experience and review of the literature.

Steroids and adrenocorticotrophic hormone (ACTH) have been used for the treatment of infantile spasms for several years. However, the use of steroids in the treatment of epilepsy beyond infantile spasms has been limited to only a few studies. We report the experience with steroids in 32 children with intractable epilepsy, not including West syndrome. In 47% there was a decrease in seizure frequency, 25% became seizure free, 11% had a seizure reduction of >50% and 11% had a seizure reduction of <50%. Our study confirms the conclusions of few previous reports of effective adjunctive steroid treatment for children with intractable epilepsy. The possible side effects, however, especially during prolonged therapy remain an important concern.     

Vitamin D status in children with intractable epilepsy, and impact of the ketogenic diet

PURPOSE: The aim of this study was to describe vitamin D status in children with intractable epilepsy prescribed newer antiepileptic drugs (AEDs) before initiation of and during 15-month treatment with the ketogenic diet (KD). METHODS: Serum vitamin D (25-OHD and 1,25-OHD) and parathyroid hormone (PTH) were assessed in prepubertal children with intractable epilepsy before initiation of and during KD therapy. Three-day weighed dietary records including KD and vitamin and mineral supplementation were obtained at baseline and at 1 month. RESULTS: Forty-five children (aged 5.1 +/- 2.7 years) were enrolled. Before KD therapy, 4% had deficient and 51% had insufficient serum 25-OHD levels. Vitamin D intake was less than recommended in 47%. Adequate vitamin D intake, fewer AEDs, and generalized seizures were associated with higher serum 25-OHD levels (p < 0.01). After 3 months on the KD, 25-OHD levels increased (p < 0.001), and PTH declined (p < 0.001). Over the next 12-month period, 25-OHD levels steadily declined (p < 0.001), and PTH did not significantly change. CONCLUSIONS: Children with intractable epilepsy treated with newer AEDs had poor vitamin D status. Their status improved over the first 3 months of KD therapy with vitamin D supplementation and slowly declined thereafter.     

左乙拉西坦添加治疗成人癫痫的疗效

目的：研究左乙拉西坦（LEV）添加治疗成人癫痫的临床疗效及安全性。方法选取江苏大学附属人民医院2010年1月～2013年12月收治的成人癫痫患者116例为研究对象。采取多阶段分层抽样法将患者分为LEV添加治疗组和常规治疗组,同时行开放性自身对照研究,观察并比较两组患者的癫痫发作控制率、治疗有效率和不良反应。结果 LEV添加治疗组的总有效率为77．6％;常规治疗组为51．7％,两组疗效的差异存在统计学意义（P＜0．01）。LEV添加治疗组不良反应（包括嗜睡、头晕、食欲下降和兴奋激动）发生率为19．0％;常规治疗组不良反应发生率为17．2％,两组的差异无统计学意义（P ＞0．05）。结论 LEV添加治疗与常规治疗相比,对各种发作类型的成人癫痫均有较好疗效,且安全性较好。     

Expression of multidrug resistance 1 gene and C3435T genetic polymorphism in peripheral blood of patients with intractable epilepsy

BACKGROUND:Increased expression of multidrug resistance 1 (MDR1) mRNA in peripheral blood of pa-tients with intractable epilepsy is not due to epilepsy drugs,but epilepsy behavior. Monitoring MDR1 ex-pression in peripheral blood is a target for MDR1 gene evaluation. OBJECTIVE: To investigate the influence of antiepileptic drugs and seizures on MDR expression in intrac-table epilepsy,and to analyze the genetic polymorphisms of C3435T in the MDR1 gene. DESIGN,TIME AND SETTING: Factorial designs and comparativ...     

左乙拉西坦治疗难治性癫痫48例的临床研究

目的：探讨左乙拉西坦（Lev）添加剂量治疗难治性癫痫的疗效和安全性。方法：采用开放性自身对照方法,对48例（儿童23例,成人25例）难治性癫痫患者进行Lev添加治疗,并随访1年以上,收集治疗后患者发作频率变化、无发作情况、不良反应以及退出原因。结果：Lev治疗难治性癫痫总有效率为64．58％,成人有效率高于儿童,对部分性癫痫综合征有效率高;3、6和12个月无发作率分别为6．25％、18．75％和16．67％,保留率为81．25％、56．25％和43．75％。总不良反应发生率为39．58％,无严重不良反应,退出的最主要原因为对疗效欠满意。结论：LEV是一种安全有效的难治性癫痫治疗药物,对部分性和全面性癫痫发作均有效。     

Bromide therapy for pediatric seizure disorder intractable to other antiepileptic drugs

Triple bromide elixir was used as an adjunctive antiepileptic drug in 11 children whose seizure disorders were intractable to other antiepileptic therapy. The patients' ages ranged from 2 to 17 years. The seizure disorders treated included photosensitive epilepsy (one case), acquired epileptic aphasia (one case), Lennox-Gastaut syndrome (three cases), and symptomatic localization-related epilepsies (six cases). Two patients' seizures completely stopped with bromide therapy. Four patients had a significant and sustained improvement on bromide therapy, while three more had a transient improvement. In these six patients with complete or significant control, the mean therapeutic dose was 33 mg bromide/kg daily, and the mean therapeutic serum concentration was 14.1 mmol/L (range, 4 to 30.5 mmol/L). The combination of bromide with valproate appeared to be particularly effective in these patients. Toxicity was minimal, and in only one patient was the medication stopped, because of anorexia and weight loss. Given the low cost, long half-life, and minimal toxicity when serum bromide concentrations are followed, bromide therapy should be considered as adjunctive antiepileptic drug therapy for patients whose seizures are intractable to other drugs.