托吡酯治疗后癫(癎)患儿体重和血浆甘丙肽的变化

目的探讨癫痫患儿托吡酯治疗后体重变化与血浆甘丙肽的关系。方法对服用托吡酯的61例癫痫患儿用放射免疫法测定治疗前后血浆甘丙肽浓度和观察身高、体重变化,并以16例健康儿童作为对照。结果①服托吡酯后22例（36．1％）体重下降,该组甘丙肽浓度降低有统计学意义（t=2．91,P〈0．01）。体重增加组甘丙肽变化没有统计学意义（t=1．67,P〉0．05）。对照组甘丙肽变化无统计学意义（t=1．72,P〉0．05）。②体重下降组中18例（81．8％）患儿食欲变差,与体重增加组相比,差异有统计学意义（X^2=28．50,P〈0．001）。③食欲差组甘丙肽浓度降低有统计学意义（t=4．84,P〈0．001）,而食欲好组下降无统计学意义（t=1．04,P〉0．05）。④癫痫患儿治疗后体重指数的下降[（17．48±2．22）kg／m^2比（15．24±2．38）kg／m^2]有统计学意义（t=8．628,P〈0．01）。对照组是增加的。结论服用托吡酯后部分癫痫患儿体重会有显著下降和食欲减退,同时伴有血浆中甘丙肽水平显著的下降。提示托吡酯治疗引起的体重降低和食欲减退可能与甘丙肽浓度降低有关。

Changes of body weight and galanin in epileptic children treated with topiramate

OBJECTIVE: Topiramate is a new broad-spectrum anti-epileptic drug. Decreased body weight and appetite are common side effects of topiramate. The side effect affects the growth and development in children greatly. Little is known about the mechanisms of topiramate-induced weight loss and decreased appetite in children with epilepsy in China and abroad. galanin is one of factors that affect appetite. It is a neuroendocrine peptide and play an important role in the control of appetite and body weight in the mechanism of hormone release. The purpose of this study was to explore the mechanism of topiramate-induced weight loss in children with epilepsy and the relation of weight loss with change of galanin, thereby to provide evidences for improvement of quality of life, compliance to treatment and reduce side effects of growth and development in children with epilepsy. METHODS: Totally 61 patients with especial epilepsy were enrolled into this study and the disease was defined by clinical manifestations and electroencephalography (EEG). Among them 32 cases had generalized seizures and 29 had local seizures. Sixteen normal children were enrolled as control group. The patients' age ranged from 0.5 to 14 (4.76 +/- 4.05) years and the patients were instructed to take 0.5 - 1 mg/kg of topiramate per day, with 0.5 - 1 mg/kg every 3 - 5 d increased to maximum of 3 - 8 mg/kg per day. Patients continued receiving the doses for 4 months. All patients' serum galanin levels and body height and weight and hepatic function were detected before and after antiepileptic drugs treatment. The galanin was detected by using radioimmunoassay. RESULTS: After treatment with topiramate (61 cases) for 4 months, plasma galanin [(22.01 +/- 8.12) pg/ml] declined as compared with baseline [(26.56 +/- 9.35) pg/ml, t = 2.85, P < 0.01] in children with epilepsy. Twenty-two of 61 patients lost weight, their plasma galanin concentration was significantly lower [(26.51 +/- 10.00) pg/ml vs. (20.45 +/- 8.09) pg/ml, t = 2.91, P < 0.01], but there was no significant change in the weight-gained patients (39/61) and control group (n = 16). In children with epilepsy, the mean value of body weight decreased as compared with the pre-treatment values, but the difference was not significant; however, the body-mass index (BMI) was significantly lower than that obtained before treatment (t = 8.628, P < 0.01). Eighteen of 22 patients who lost weight had decreased appetite, but only five of 39 patients who gained weight showed decreased appetite (chi(2) = 28.50, P < 0.001). The mean value of plasma galanin declined after treatment in patients (23 cases) with decreased appetite [(18.35 +/- 7.80) pg/ml vs. (27.28 +/- 6.90) pg/ml, t = 4.84, P < 0.001]; while plasma galanin did not change significantly after treatment in patients (38 cases) without decreased appetite [(24.23 +/- 7.66) pg/ml vs. (26.12 +/- 5.49) pg/ml, t = 1.04, P > 0.05]. CONCLUSION: Topiramate treatment may lower the body weight and reduce appetite in part of children with epilepsy which may be mediated by the reduced plasma galanin level.