托吡酯、心理疗法、舍曲林联合治疗难治性癫痫的疗效

目的探讨托吡酯、心理疗法、舍曲林联合治疗难治性癫痫的疗效及安全性。方法 280例难治性癫痫患者,根据抑郁自评量表(SDS)评分分为无抑郁组(120例)及抑郁组(140例),每组再均分为对照组和治疗组。无抑郁对照组及抑郁对照组患者的治疗为既往治疗方案的基础上加用托吡酯片50 mg口服,每2 d 1次。无抑郁治疗组的治疗:第1步:在既往治疗方案的基础上加用托吡酯片50 mg口服,每2 d 1次;第2步:心理治疗。抑郁治疗组在同无抑郁治疗组进行前2步相同治疗的基础上加用第3步,联合舍曲林每日50 mg,早餐后顿服,连续服用3个月。观察各组的癫痫改善率和有效控制率、SDS评分及生活质量量表-31(QOLIE-31)评分,并对其结果进行比较。结果心理治疗能提高无抑郁组的癫痫改善率和有效控制率,但差异无统计学意义(P>0.05);可降低SDS评分,提高QOLIE-31评分,差异有统计学意义(P<0.05)。3步疗法能显著提高抑郁组的癫痫改善率和有效控制率,显著降低SDS评分和提高QOLIE-31评分,差异有统计学意义(P<0.01),且未发生严重不良反应。结论托吡酯、心理疗法、舍曲林联合治疗是一种安全有效的抗癫痫方案,适用于大部分难治性癫痫患者。

Effect of combined therapy of topiramate,psychotherapy and sertraline in the treatment of refractory epilepsy

Objective To explore the efficacy and security of combined therapy of topiramate, psychotherapy and sertraline in the treatment of refractory epilepsy. Methods Two hundred and eighty refractory epileptic patients were divided into non depressed group （120 eases ） and depressed group （140 cases ） according to the score of self-rating depression scale （SDS）. Both groups were divided into control group and treatment group. The treatments of non depressed control group and depressed control group were adding topiramate 50 mg d -2 on the previous treatments. The treatment of non depressed treat- ment group was divided into two steps. The first step ,topiramate 50 mg d-2 was added on the previous treatments. The second step was psychotherapy. The treatment of depressed treatment group was divided into three steps. The first two steps were same with the treatment of non depressed treatment group. The third step was adding sertraline 50 mg d - 1. Sertraline was taken after breakfast, and the period of treatment was three months. The improvement rate, effective control rate, SDS and quality of life in epilepsy-31 （ QOLIE-31 ） were used to evaluate the efficacy and the results were compared. Results Compared with the control group, psychotherapy raised improvement rate and effective control rate of non depressed group. But there was no statis- tical significance（P 〉 0. 05）. Psychotherapy decreased the SDS scores and increased the QOLIE-31 scores of non depressed group, the differences were significantly（ P 〈 0.05 ）. Three-step therapy significantly raised improvement rate and effective con- trol rate of depressed group, it also significantly decreased the SDS scores and increased the QOLIE-31 scores of depressed group ,the differences were statistical significance （ P 〈 0.01 ）. There was no severe adverse effect. Conclusion Combined therapy of topiramate ,psychotherapy and sertraline is a safe and effective antiepileptic therapy and it can be applied to the majority patients with refrac