左乙拉西坦联合用药在成人颞叶癫痫术后早期的应用

目的观察新型抗痫药物左乙拉西坦（LEV）联合治疗对成人颞叶癫痫术后早发性癫痫（APOS）的预防作用。方法选择近1年来进行手术的成人颞叶癫痫患者60例,术后仅服用卡马西平（CBZ）者为对照组和术后应用CBZ联合LEV者为实验组,观察两组APOS例数、白细胞数、意识、精神状态、CBZ药浓度和胃肠道反应。结果对照组8例发生APOS,实验组为2例,有显著性差异,实验组白细胞、血小板、CBZ药浓度明显变化,未见明显胃肠道反应。实验组有5例出现烦躁或夜间睡眠障碍,而对照组仅1例。结论成人颞叶癫痫术后LEV联合CBZ较单药CBZ预防APOS有良好疗效,短期应用未见明显副作用,但可能会出现烦躁或睡眠障碍。     

左乙拉西坦治疗各型癫100例临床疗效观察

目的观察左乙拉西坦（开普兰）治疗各型癫痫的疗效。方法用开放性试验的方法对100例癫痫患者进行了添加转单药以及首诊单药的开普兰治疗,观察其疗效及不良反应。结果总有效率46．0％,控制率15．0％,对各型癫痫均有效。不良反应出现率17．0％。结论开普兰是一种安全、有效的抗癫痫药物,对各型癫痫均有效。     

左乙拉西坦在儿童癫中的应用

左乙拉西坦是一种新型抗癫药物,由于其不良反应少、安全性高,已广泛应用于儿童局灶性及全面性癫的治疗。本文对左乙拉西坦在儿童癫及儿童癫综合征中单药及添加使用的疗效及安全性做一综述。     

左乙拉西坦单药治疗各类癫痈的疗效

左乙拉西坦是一种新型作用机制的抗癫痫药物,其抗痢机制可能是通过影响突触囊泡蛋白SV2A来实现。本文就该药物单一治疗各类癫痫（新诊断癫痫、部分性发作、全面性发作及手术后癫痫等）的疗效和耐受性研究做介绍。     

左乙拉西坦在癫痫治疗中的作用

详细总结新型抗癫痫药物左乙拉西坦的药物代谢动力学特点、药物相互作用、抗癫痫作用机制、对成人及儿童各种不同发作类型癫痫的添加治疗及单药治疗研究进展、安全性评价及常见不良反应、特异质性不良事件、认知功能及生活质量影响。结论该药具有理想的药动学特性、较高的安全性及抗癫痫效能,对认知功能无明显损害,适应证扩大后已经可用于16岁以上人群部分性发作癫痫的单药治疗、全面性发作癫痫中某些特定发作类型的添加治疗。     

左乙拉西坦治疗成人癫痫的疗效及安全性分析

目的分析左乙拉西坦在成人癫痫患者中的疗效、耐受性及安全性。方法选取我院2013-02—2014-06收治的98例癫痫患者为研究对象,随机分为试验组(LEV治疗)和对照组(常规用药)各49例,疗程40d,观察疗效及不良反应。结果观察组有效率81.6%,对照组为61.2%,2组疗效比较差异有统计学意义(P0.05)。2组指标异常、厌食、嗜睡等不良反应差异无统计学意义(P0.05)。个别患者出现皮疹、白细胞下降症状并不是应用左乙拉西坦造成的。结论左乙拉西坦(LEV)作为一种新型药物,安全性较高,在癫痫治疗的初、中期患者耐受性好,单独使用其治疗效果也十分显著。     

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。     

左乙拉西坦治疗儿童癫痈完全控制及其影响因素的研究

目的：研究左乙拉西坦治疗儿童癫痫疗效达完全控制及其影响因素,为临床合理使用左乙拉西坦,使其效果最大化提供依据。方法：采用前瞻性研究,按纳入及排除标准纳入病例;疗程≥3个月,统计完全控制率;对完全控制组和非完全控制组患者进行不同发作类型、治疗方案、年龄及病因等对照研究。结果：共纳入癫痫患儿110例,其中完全控制56例（50．9％）。不同发作类型、病因及不同治疗方案的完全控制率比较差异有统计学意义（P〈0．05）。结论：左乙拉西坦治疗儿童癫痫有较高的完全控制率,完全控制率与发作类型、治疗方案及病因有关。     

奥卡西平联合左乙拉西坦对成人颞叶癫痫患者认知功能的影响

目的 观察奥卡西平（OXC）+左乙拉西坦（LEV）对成人颞叶癫痫患者认知功能的影响。方法 选择2020年1月～2022年10月接诊的70例成人颞叶癫痫患者,采用随机数字表法分为：观察组（纳入35例,行OXC+LEV治疗）、对照组（纳入35例,行OXC治疗）,评价组间P300潜伏期及波幅、临床记忆量表（CMS）、成人韦氏智力量表（WAIS-RC）以及不良反应情况。结果（1）治疗前,两组的P300潜伏期及波幅（P3波幅、N2波潜伏期、P2波潜伏期）无明显差异,P>0.05;治疗3个月后,组间P3波幅无明显差异（P>0.05）,但观察组N2波潜伏期、P2波潜伏期较短（P<0.05）;(2)治疗前,组间CMS评分（图像自由回忆、联想记忆、指向记忆）无明显差异,P>0.05;治疗3个月后,组间联想记忆评分无明显差异（P>0.05）,但观察组图像自由回忆、指向记忆评分较高（P<0.05）;(3)治疗前,组间WAIS-RC评分[操作智商（PIQ）、言语智商（VIQ）、总智商（FIQ）]无明显差异,P>0.05;治疗3个月后,组间PIQ、VIQ评分无明显差异（...     

难治性颞叶癫痫术后急性发作对远期预后的预测价值

目的探讨药物难治性颞叶癫痫术后急性发作对远期预后的影响。方法回顾性分析我院自2009年6月-2010年6月收治的52例药物难治性颞叶癫痫患者的临床资料,所有患者均接受外科治疗,术后定期门诊或电话随访。根据术后7天患者有无急性发作,分为2组,分为实验组(复发),对照组(未复发)。将2组患者随访资料、远期预后(5年)等进行对比分析。结果实验组癫痫控制满意率为35.0%,对照组控制满意率为68.8%,实验组明显低于对照组,差异有统计学意义(χ2=5.683,P=0.017)。在多元Logistic回归分析结果中,复发次数、术前使用抗癫痫药物数量、术后脑电图,术后急性发作与术前习惯性发作相似是影响远期预后的独立影响因子。结论难治性颞叶癫痫术后急性发作对患者远期预后存在影响,已明确的影响因子包括:复发次数、术前抗癫痫药≥3种,术后脑电图及术后急性发作与术前习惯性发作相似。     

Multicenter double-blind, randomized, placebo-controlled trial of levetiracetam as add-on therapy in Chinese patients with refractory partial-onset seizures

Purpose:   To evaluate efficacy and tolerability of levetiracetam (LEV; Keppra^®) as add-on therapy in Chinese patients with refractory partial-onset seizures.
Methods:   In this multicenter, double-blind, randomized, placebo-controlled trial, 206 patients aged 16–70 years with uncontrolled partial-onset seizures were randomized to receive LEV (n =103) or placebo (n =103); 202 patients (LEV, n =102; placebo, n = 100) comprised the intent-to-treat population. An 8-week historical baseline period confirmed eligibility according to seizure count. The 16-week treatment period consisted of a 4-week up-titration period (LEV, 1,000–3,000 mg/day in two equal divided doses) followed by a 12-week maintenance period. Efficacy assessments were based on weekly frequency of partial-onset seizures during the 16-week treatment period.
Results:   LEV significantly decreased weekly partial-onset seizure frequency over placebo by 26.8% (p  < 0.001). Median percentage reductions in weekly partial-onset seizure frequency from historical baseline were 55.9% for LEV and 13.7% for placebo (p  < 0.001). The ≥50% responder rates were 55.9% for LEV, compared with 26.0% for placebo (p  < 0.001). Freedom from partial-onset seizures during treatment period was achieved by 11 LEV patients (10.8%) and 2 placebo patients (2.0%) (p = 0.012). Adverse events were reported by 65 LEV-treated patients (63.1%) and 62 placebo-treated patients (60.2%); most were of mild-to-moderate intensity. The most common adverse events were somnolence (LEV, 17.5%; placebo, 17.5%), decreased platelet count (LEV, 9.7%; placebo, 9.7%), and dizziness (LEV, 7.8%; placebo, 13.6%).
Discussion:   Add-on LEV was effective and well-tolerated in Chinese patients with refractory partial-onset seizures.     

Multicenter double-blind, randomized, placebo-controlled trial of levetiracetam as add-on therapy in patients with refractory partial seizures. European Levetiracetam Study Group

PURPOSE: To evaluate the efficacy and tolerability of levetiracetam (LEV, Keppra) as add-on therapy in patients with refractory partial seizures. METHODS: In this European multicenter, double-blind, randomized, placebo-controlled trial, LEV (500 or 1,000 mg twice daily) was compared with placebo as add-on therapy in 324 patients with uncontrolled simple or complex partial seizures, or both, with or without secondary generalization. After enrollment, three parallel groups were assessed during a baseline period of 8 or 12 weeks, followed by a 4-week titration interval and a 12-week evaluation period. RESULTS: LEV significantly decreased partial seizure frequency compared with placebo. A reduction in seizure frequency of > or =50% occurred in 22.8% of patients in the 1,000-mg group and 31.6% of patients in the 2,000-mg group, compared with 10.4% of patients in the placebo group. Administration of LEV did not affect plasma concentrations of concomitant antiepileptic drugs or alter vital signs or laboratory parameters. No significant difference in the incidence of adverse events was observed between treatment groups (70.8% for the 1,000-mg group and 75.5% for the 2,000-mg group), or between the LEV and placebo groups (73.2% for placebo group). The most commonly reported adverse effects in the LEV group were asthenia, headache, and somnolence. CONCLUSIONS: The antiepileptic efficacy and tolerability of LEV (1,000 mg/d and 2,000 mg/d, administered in two divided doses) as add-on therapy was established in patients with refractory partial seizures in this clinical study.     

颞叶癫痫患者手术后早期发作对远期疗效的影响

目的：探讨颞叶癫痫患者手术后早期发作的影响因素及其对预后的影响。方法回顾性分析2011年2月至2012年10月首都医科大学附属北京天坛医院神经外科手术治疗的96例颞叶癫痫患者的临床资料,并进行随访,分析癫痫手术后早期发作的影响因素及其对长期预后的影响。结果术后随访所有患者EngelⅠ级73例,EngelⅡ级11例,EngelⅢ级9例,EngelⅣ级3例。15例患者术后出现APOS,随访EngelⅠ级8例,EngelⅡ级3例,EngelⅢ级3例,EngelⅣ级1例。患者的年龄、性别、病程、术前发作频率、发作类型、MRI表现、切除侧别、术后病理等对术后早期发作无影响。出现术后早期发作的患者的癫痫缓解率明显低于无术后早期发作的患者（P＜0．05）,惯常发作的患者的癫痫缓解率明显低于非惯常发作的患者（P＜0．05）。结论颞叶癫痫患者术后早期发作的出现提示预后不良,发作形式表现为惯常发作的患者更容易出现癫痫复发。     

Effects of levetiracetam as an add-on therapy on cognitive function and quality of life in patients with refractory partial seizures

This study comprised two phases and evaluated the effects of levetiracetam (LEV), as an add-on treatment, on cognitive function and quality of life (QOL) in patients with refractory partial seizures. The short-term phase employed a randomized, double-blind, placebo-controlled design including an 8-week baseline period, 4-week titration interval, and 12-week period at the maximum LEV dose (1500 mg twice daily). The long-term phase was an open-label study in which the maximum LEV dose was administered for another 24 weeks. Neuropsychological tests and the 31-item Quality of Life in Epilepsy (QOLIE-31) inventory were administered at baseline, at the end of the short-term phase, and at the end of the long-term phase. Twenty-four eligible patients entered into the final phase. After short-term LEV treatment, performance time on the Wisconsin Card Sorting Test (WCST) and Delayed Logic Memory significantly improved for the patient group, but not the control group. Subscale scores on the QOLIE-31, including scores on Cognitive Functioning and Social Function, also improved only for the LEV group. At the end of the long-term phase, these improvements were maintained, and both groups performed better in more areas, as measured by the Trail Making Test, WCST, and Delayed Visual Memory in the neuropsychological battery and the QOLIE-31 subscales Overall QOL and Health Status. Thus, as an adjunctive therapy, LEV did not negatively affect and, in a way, improved cognitive function and QOL in patients with medically refractory partial seizures. Some of these improvements may be maintained during long-term treatment.     

Prognostic significance of acute postoperative seizures in extra-temporal lobe epilepsy surgery

ObjectiveThis study aims to assess the prognostic value of acute postoperative seizures (APOS) in patients surgically treated for drug-resistant extra-temporal lobe (ET) epilepsy.MethodsWe studied 77 consecutive patients with ET epilepsy who underwent epilepsy surgery and were followed up for at least 2 years (mean duration of follow-up 6.2 years, range 2–14). Medical charts were reviewed to identify APOS, defined as ictal events with the exception of auras occurring within the first 7 days after surgery. Seizure outcome was determined at annual intervals. Patients who were in Engel Class I at the last contact were classified as having a favourable outcome.ResultsSeizure outcome was favourable in 47 patients (61%). The occurrence of APOS and incompleteness of resection were found to be independently associated with unfavourable outcome in a multiple regression model including all preoperative factors identified as outcome predictors in univariate analysis. Duration of illness was the only independent preoperative predictor of APOS.ConclusionsOur study suggests that APOS may predict long-term outcome in patients undergoing resective surgery for ET epilepsy. Given some study limitations, our findings should be regarded as preliminary and need confirmation from future larger, prospective, multicentre studies.SignificanceCaution may be required in the clinical management of patients experiencing APOS.     

Sequential intrarectal diazepam and intravenous levetiracetam in treating acute repetitive and prolonged seizures

In this retrospective study of institutionalized patients with mental retardation, we present the efficacy and safety of sequential treatment with intrarectal diazepam (IRD) gel (Diastat) and intravenous levetiracetam (IVL) in comparison with either treatment alone for acute repetitive or prolonged seizures (ARPS). We defined ARPS as ≥3 seizures of any type within 1 h or a single seizure of any type lasting ≥3 min. Eighty‐eight ARPS episodes were treated in 25 patients (14 female, age 21–72 years), with mainly symptomatic generalized epilepsy. There were no adverse events directly attributable to the administration of IRD or IVL. Seizure recurrence within 4 h of treatment, the primary outcome measure, was significantly lower after combined sequential IRD + IVL treatment (3 of 36) compared to IRD alone (6 of 24, p = 0.048) or IVL alone (10 of 28, p = 0.039). There was no statistically significant difference between the individual IRD and IVL treatments (p = 0.604). The estimated odds ratio (OR) indicated that the risk of seizure recurrence was higher after IRD or IVL monotherapy compared to combined IRD + IVL treatment. Subsequent emergency room (ER) transfers following seizure recurrence were least likely after IVL treatment (10%) compared to combined IRD + IVL (67%) or IRD (83%) treatment. These findings suggest that although IRD or IVL monotherapy is efficacious, the combination is superior in controlling ARPS in this special group of institutionalized patients. In addition, we speculate that a more reliable onset of action after IVL treatment results in rapid seizure control and fewer ER transfers, despite seizure recurrence.