左乙拉西坦递增疗法对局灶性癫痫患儿脑神经递质及睡眠结构的影响

目的探讨左乙拉西坦递增疗法治疗局灶性癫痫患儿临床疗效及可能作用机制。方法选择2018年3月至2019年6月我院收治的局灶性癫痫患儿85例,采用随机数字表法分为观察组43例和对照组42例,对照组给予丙戊酸钠递增疗法,观察组给予左乙拉西坦递增疗法。治疗24周后,比较两组临床疗效、认知功能、脑神经递质、睡眠质量。结果观察组癫痫患儿有效率高于对照组(χ2=4.754,P<0.05)。语言智商、操作智商、总智商评分高于对照组(P<0.05)。γ-氨基丁酸(GABA)、5-羟色胺(5-HT)高于对照组,谷氨酸(Glu)、乙酰胆碱(Ach)低于对照组(P<0.05)。Ⅰ+Ⅱ期占比低于对照组,Ⅲ+Ⅳ期、快速眼动睡眠相(REM)占比高于对照组(P<0.05)。结论左乙拉西坦递增疗法有助于提高局灶性癫痫患儿临床疗效,改善认知功能,可能与调节脑神经递质水平、矫正睡眠结构紊乱等因素有关。

The impact of lexiacetam step-up therapy on brain neurotransmitters and sleep structure in children with focal epilepsy

Objective To investigate the clinical efficacy and possible mechanism of lexiacetam step-up therapy for children with focal epilepsy.Methods Eighty-five sick children with focal epilepsy from March 2018 to June 2019 were divided into observation group(n=43)and control group(n=42).The control group was given sodium valproate step-up therapy while the observation group was given lexiacetam step-up therapy.After 24 weeks of therapy,clinical efficacy,cognitive function,brain neurotransmitters and sleep quality were compared between two groups.Results The effective rate in the observation group was higher than that of control group(χ2=4.754,P<0.05).Verbal IQ,operational IQ and total IQ score in the observation group were higher than that in the control group(P<0.05).The levels of gamma-aminobutyric acid(GABA)and 5-hydroxytryptamine(5-HT)were higher while the levels of glutamate(Glu)and acetylcholine(Ach)were lower in the observation group than those in the control group(P<0.05).The percentage ofⅠ+Ⅱphase were lower but percentage ofⅢ+Ⅳphase and percentage of rapid eye movement sleep phase(REM)were higher in the observation group than those in the control group(P<0.05).Conclusion Lexiacetam step-up therapy can help to improve the clinical efficacy and cognitive function of children with focal epilepsy.It may be related to adjusting brain neurotransmitters level and correcting the disorder of sleep structure.