新型和传统抗癫痫药治疗新诊断癫痫患者的评价

目的评价新型和传统抗癫痫药(AEDs)单药治疗新诊断癫痫患者的疗效及安全性。方法前瞻性收集143例新诊断癫痫患者,分为卡马西平(CBZ)、丙戊酸钠(VPA)、托吡酯(TPM)和拉莫三嗪(LTG)治疗组,其中CBZ用于癫痫部分性发作,VPA用于癫痫全面性发作,而TPM和LTG用于各种类型癫痫发作,至少观察1年。采用生存分析Kaplan-Meier法比较治疗后癫痫初次发作时间、治疗失败时间,同时比较各组患者达"6月、1年无发作"比例和药物不良反应。结果 4组AEDs单药治疗后至癫痫初次发作时间、治疗失败时间的差异均无统计学意义(P0.05);CBZ、VPA、TPM和LTG组"6月无发作"率分别为80%、78%、87.9%、63.3%(均P0.05);"1年无发作"率分别为70%、66%、66.7%、50%(均P0.05)。TPM组不良反应率为63.3%,高于CBZ组(20%)、VPA组(24%)(均P0.01),而LTG组不良反应率为16.7%,与CBZ、VPA组相当(均P0.05)。结论从疗效和安全性综合考虑,新型AEDs治疗癫痫并不优于传统AEDs,其中TPM轻、中度不良反应还明显高于传统AEDs。     

难治性癫痫与多药耐药基因1C3435T多态性的相关性

目的 探讨多药耐药基因1(MDR1)C3435T位点多态性与汉族难治性癫痫(RE)的关系. 方法 收集170例诊断明确、治疗合理的汉族癫痫患者,根据是否符合RE诊断标准将其分为RE组(91例)和非RE组(79例).RE定义为:至少观察2年,按患者发作类型正确使用≥2种对该发作类型有效的抗癫痫药物,单药前、后分别使用或联合使用,仍每月发作≥1次达2年及以上者.采用多聚酶链反应限制性片段长度多态性方法检测患者外周血MDR1基因C3435T多态性. 结果 RE组CC、CT、TT基因型分别占48.4%、40.7%、11.0%,非RE组分别占40.5%、38.0%、21.5%,总体差异无统计学意义(x2=3.615,P=0.164).RE组患者C3435T等位基因C、T频率分别为68.7%、31.3%,非RE组患者分别为59.5%、40.5%,差异也无统计学意义(x2=3.112,P=0.080).根据病因将患者分为原发性癫痫、症状性或隐源性癫痫2组,结果示2组患者中RE亚组和非RE亚组C3435T基因型分布、等位基因频率差异均无统计学意义(P＞0.05). 结论 本研究未发现MDR1基因C3435T多态性与汉族RE有关.

Abstract：

Objective To clarify the relation between the C3435T polymorphism of multidrug resistance 1 (MDR1) gene and human refractory epilepsy (RE) in ethnic Han Chinese. Methods We collected 170 patients with epilepsy, whose diagnoses were correct and treatments were reasonable. RE was defined as having uncontrolled seizures that occurred with an average frequency of at least once a month for a period of at least 2 years; during the 2-years period, at least 2 different antiepileptic drugs (AEDs) were used daily, either singly or in combination. According to the definition, 91 patients were classified into RE group and the other 79 patients into non-RE group. A 5-mL venous blood sample was taken from the patients for DNA extraction and genotyping. Genotype of C3435T polymorphism in MDR1 gene was determined by polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP). Results The distribution of CC, CT, TT genotypes was 48.4%, 40.7%,11.0% in RE group, and 40.5%, 38.0%, 21.5% in non-RE group, respectively; no significant differences of C3435T genotype were noted between the 2 groups (x2=3.615, P=0.164). The C and T allele frequencies were 68.7%, 31.3% in RE group, and 59.5%, 40.5% in non-RE group, respectively; no significant differences were found between 2 groups (x2=3.112, P=0.080). Patients were divided into primary epilepsy group and cryptogenic or symptomatic epilepsy group according to the etiology;analyses of the genotype and allele of C3435T in the sub-groups (RE and non-RE subgroups) of this 2 groups were similarly unremarkable. Conclusion No association between the C3435T polymorphism in MDR1 gene and RE in ethnic Han Chinese is noted.     

炎性反应与癫痫

越来越多的研究显示炎性反应与癫痫的发病密切相关。在炎性反应过程中,血脑屏障完整性被破坏,通透性增加,白细胞浸润;胶质细胞活化、增生,分泌大量的促炎性细胞因子并上调其相关受体。这些反应进一步使神经元兴奋性增高,诱导癫痫发作;产生细胞兴奋性毒性,诱发神经元死亡,破坏脑组织,形成海马硬化等病理改变;使病程迁延反复,产生对常规抗癫痫药物的抵抗等。本文主要对炎性反应与癫痫发生、发展的关系及相关治疗做一综述。     

不同撤药速度对癫痫患者复发的影响

目的探讨不同撤药速度对癫痫患者复发的影响。方法前瞻性收集达≥2年无发作癫痫患者的临床资料,根据撤药速度分为正常(撤药期6个月左右)和缓慢组(撤药期>6个月)。随访至癫痫复发或至少随访2年。结果共收集76例撤药癫痫患者(正常组47例,缓慢组29例),平均随访(2.0±1.5)年。随访终点累计复发率为53.9%;两组患者撤药后3、6、12、24个月癫痫复发率分别为12.8%vs.6.9%(P=0.41)、29.8%vs.13.8%(P=0.11)、42.6%vs.41.4%(P=0.92)、50.0%vs.55.2%(P=0.66),差异均无统计学意义。Kaplan-Meier生存分析法显示,两组患者撤药至复发时间差异也无统计学意义(Log-Rank test掊2=0.019,P=0.889)。结论对达≥2年无发作癫痫患者,与6个月撤药相比,撤药时间大于6个月对复发无明显影响。     

癫痫患者撤药的研究现状

药物治疗仍是目前治疗癫痫的主要手段,癫痫发作得到控制后,患者及其家属最关心的是撤药问题.合理撤药对降低复发风险、减少抗癫痫药物( anti-epileptic drugs,AEDs)产生的不良反应、改善癫痫患者生活质量具有重要意义.但癫痫患者的撤药时机、撤药速度及影响撤药后癫痫复发的因素,目前尚不明确,现对癫痫患者撤药的研究现状作一综述.