拉莫三嗪治疗小儿难治性癫痫35例临床研究

目的应用拉莫三嗪联合治疗3-14岁的难治性癫痫儿童35例。方法对于全身性发作，无论原发性或是继发性，联合应用拉莫三嗪能有效控制癫痫发作。结果拉莫三嗪尤其适用治疗复杂部分性发作等伴有精神障碍的难治性癫痫，疗效确切。结论多药联合治疗Lennox综合征时应首选拉莫三嗪。拉莫三嗪的毒副反应小，但皮疹是其常见且较为严重的副作用。拉莫三嗪与卡马西平等酶诱导剂合用时可适当加大剂量；临床应用拉莫三嗪时应考虑本国人群的特质，并加强拉莫三嗪血药浓度的监测。     

卡马西平抗癫痫疗效的Meta分析

目的：评价卡马西平治疗癫痫的疗效。方法：利用计算机检索外文数据库PubMed、MEDLINE、EMBASE、OMNI、Cochrane 图书馆和中文数据库中国中医药数据库、中国知网、万方数据库、中国生物医学文献数据库、维普数据库、中国期刊全文数据库。此外还手工检索相关会议论文汇编及尚未发表的灰色文献。时间为建库至2016年3月,查找卡马西平治疗癫痫的随机对照试验（RCT）,并进行文献质量评价和相关资料的提取,使用RevMan5.3版软件进行Meta分析。结果：根据文献纳入及排除标准,共纳入6篇符合要求的文献,经Meta分析结果显示,总有效率OR=-3.01,95%CI[1.92,4.71],Z=4.82,P<0.00001;控制率OR=-1.66,95%CI[1.14,2.42],Z=2.64,P=0.008;不良反应发生率OR=-0.49,95%CI[0.31,0.78],Z=3.03,P=0.002。结论：卡马西平抗癫痫疗效确切。     

拉莫三嗪与其他抗癫痫药

拉莫三嗪 (利必通 )为苯基三嗪类新型抗癫痫药 ,属电压门控钠通道阻滞剂。临床主要用于治疗癫痫 ,也可用于Lennox -Gastaut综合征的癫痫发作。拉莫三嗪与其他抗癫痫药物合用 ,可能发生有临床意义的相互作用 ,应予注意。处方 1:拉莫三嗪与卡马西平拉莫三嗪 5 0mg× 6 0　 2 5mgqdpo(连服 2周后遵医嘱增加剂量 )卡马西平 0 .2g× 10 0　 0 .2gtidpo分析 :本方用于Lennox -Gastaut综合征的癫痫发作。用药后出现头晕、共济失调、复视等中枢神经系统反应 ,且未能很好的控制癫痫发作。两药合用 ,卡马西平诱导肝药酶使拉莫三嗪代谢加速 ,血药浓度…     

拉莫三嗪添加与替换治疗丙戊酸治疗无效的癫痫患者的临床疗效对比分析

目的:对比分析在丙戊酸治疗无效的癫痫患者中采用拉莫三嗪不同应用方案的临床疗效。方法:将2013年2月~2014年10月间收治的70例接受丙戊酸治疗无效的癫痫患者作为观察对象,随机分为应用拉莫三嗪替换丙戊酸治疗的对照组,在丙戊酸治疗方案同时添加拉莫三嗪治疗的观察组,每组35例。对比两组治疗后的临床疗效及副作用发生率。结果:两组入组时癫痫月平均发作次数及每次平均发作时间比较,差异无统计学意义(P0.05),而在治疗6个月后,观察组癫痫月平均发作次数及每次平均发作时间均明显优于对照组(P0.05)。同时观察组治疗总有效率明显高于对照组(P0.05),但两组药物副作用发生率比较无统计学差异(P0.05)。结论:在丙戊酸治疗无效的癫痫患者治疗中添加拉莫三嗪可有效提高癫痫的临床疗效。     

MHC区域HLA-B类基因与抗癫痫药诱发重症药疹的相关性研究

目的探讨HLA-B类基因与抗癫痫药物诱发重症药疹的相关性,了解重症药疹的免疫学发病机制。方法收集25例抗癫痫药物诱发重症药疹患者和50例耐受对照血样,提取DNA,应用序列特异性引物-聚合酶链反应法(PCR-SSP)分型HLA-B基因,PLINK1.07软件分析HLA-B等位基因频率在患者组和耐受对照组之间差异。结果 (1)病例组携带HLA-B*1502等位基因显著高于耐受对照组(P=9.6×10~(-6),OR=10.92,95%CI:3.07～41.00)。HLA-B*1502携带率,很大程度是由卡马西平引起(P=7.0×10~(-6),OR=36,95%CI:4.65～375.97),这种增高趋势也存在苯巴比妥诱发重症药疹组(P=0.013,OR=45, 95%CI:1.47～7827.55),但拉莫三嗪组未见相关性(P=0.879,OR=0.33,95%CI:0.01～8.01)。(2)病例组携带HLA-B*40:01等位基因低于耐受对照组(P=0.045,OR=0.18,95%CI:0.03～0.97)。结论 HLA-B*40:01可能在抗癫痫药物诱发重症药疹中扮演一种保护因素。     

拉莫三嗪在丙戊酸治疗无效癫痫患者中的应用价值

目的探析拉莫三嗪在丙戊酸治疗无效癫痫中的临床疗效和安全性。方法选取郑州市第七人民医院神经内科2012年1月至2013年1月收治的86例经丙戊酸治疗无效癫痫患者,添加或替换为拉莫三嗪采用阶段治疗,按第1阶段（1~8周）、第2阶段（9~20周）、第3阶段（21~28周）、第4阶段（29~40周）分别采用不同剂量拉莫三嗪配伍或不配伍,分析临床疗效和不良反应发生情况。结果联合用药期完全控制率为72.09%,总有效率为89.53%,单药治疗期癫痫再发作率为23.21%,总有效率为76.79%,第2阶段末与第4阶段末有效率比较差异有统计学意义（χ2=4.2105,P〈0.05）;治疗期间皮疹、嗜睡、恶心呕吐、食欲减退、倦怠乏力、头晕、烦躁易怒、记忆力减退等不良反应率为29.07%。联合用药期拉莫三嗪血药浓度为（9.65±3.85）μg/ml,明显高于单用药期的（4.72±2.91）μg/ml（t=8.1777,P〈0.01）;Pearson相关性分析显示,拉莫三嗪和丙戊酸血药浓度成正相关（r=0.3998,P〈0.05）。结论拉莫三嗪联合丙戊酸类抗癫痫药疗效显著,不良反应少,患者耐受性高,用药安全,拉莫三嗪在血药浓度较高水平时,疗效显著,在治疗期间要严密监测拉莫三嗪的血药浓度。     

拉莫三嗪治疗癫痫合并抑郁障碍患者的疗效观察

选用80例癫痫合并抑郁障碍患者作为观察对象,采用随机数字表法将患者分成观察组和对照组,对照组采用卡马西平治疗,观察组采用拉莫三嗪治疗。治疗12w,观察治疗效果。一年后电话随访,观察复发情况。观察组治疗总有效率明显比对照组高,观察组PHQ-9评分、不良反应和一年内复发率明显低于对照组,有统计学意义(P0.05)。对癫痫合并抑郁障碍患者给予拉莫三嗪治疗提高了治疗总有效率,可以改善患者的抑郁症状,而且不良反应小、复发率低,具有较高的应用价值。     

小剂量丙戊酸联合拉莫三嗪对癫痫患者症状改善及不良反应发生率的影响

目的探究小剂量丙戊酸联合拉莫三嗪对癫痫患者症状改善及不良反应发生率的影响。方法选取2015年1月~2016年5月我院74例癫痫患者,按照随机抽签方式进行分组,对照组37例予以丙戊酸治疗,观察组37例采用小剂量丙戊酸联合拉莫三嗪治疗,观察比较两组临床疗效及不良反应发生率,并统计两组治疗前后症状(发作次数、发作持续时间、累及导联数与癫痫放电)改善情况。结果治疗后观察组总有效率94.59%高于对照组75.68%,发作持续时间、发作次数、累及导联数与癫痫放电均低于对照组,不良反应发生率10.81%低于对照组40.54%,差异具有统计学意义(P0.05)。结论小剂量丙戊酸联合拉莫三嗪治疗癫痫患者疗效显著,改善患者临床症状,降低不良反应发生率。     

拉莫三嗪添加-替换治疗丙戊酸治疗无效的 癫痫患者的疗效

目的:探讨丙戊酸治疗无效的癫痫患者采用拉莫三嗪添加-替换治疗的疗效。方法:丙戊酸治疗无效的癫痫患者100例,随机分为对照组和观察组各50例,对照组给予拉莫三嗪单独用药治疗,观察组给予拉莫三嗪与丙戊酸联合用药治疗,分析2组治疗有效率、治疗前后发作次数、每次持续时间、血药浓度以及不良反应发生率。结果:与对照组相比,观察组的总有效率高于对照组,不良反应发生率低于对照组,治疗后发作次数和每次发作持续时间低于对照组,血药浓度高于对照组,差异均有统计学意义(P0.05)。结论:对于丙戊酸治疗无效的癫痫患者采用拉莫三嗪添加-替换治疗可提升疗效。     

拉科酰胺治疗神经病理性疼痛的研究进展

神经病理性疼痛作为一种顽症,严重影响患者的生存质量,医学界一直在寻找更好的治疗药物.基于癫痫和疼痛都有神经元回路的异常活动和异位放电的共同特征,抗癫痈药物在治疗神经病理性疼痛领域一直占有重要地位.以钠通道为疼痛治疗靶点的抗癫痫药物有苯妥英钠、卡马西平、拉莫三嗪、奥卡西平、拉科酰胺等.     

中医药治疗前列腺炎随机对照试验的系统评价

目的系统评价中医药疗法治疗前列腺炎的疗效与安全性。方法用Cochrane协作网系统评价方法,检索Cochrane临床对照试验资料库、中国循证医学／Cochrane中心数据库、PubMed、CBM、中国学术会议论文全文数据库、中国学位论文全文数据库及中国中医药数据库检索系统,结合手T检索相关期刊及灰色文献,检索时间截至2007年1月15日,纳人中医药疗法治疗前列腺炎的随机对照试验（RCT）。由2名评价者采用改良Jadad量表共同评价纳入研究的方法学质量,采用RevMan4．3软件对临床同质性研究进行Meta分析,反之则进行定性评价,潜在的发表偏倚采用“倒漏斗”图示分析。结果在有效性方面,共纳入52个以中文发表的RCT（,1：5209）,其中22个报告了随机分组方法,9个为高质量（改良]adad量表评分≥4分）。结果显示,部分中医药疗法或联合西医疗法用于前列腺炎患者在缓解症状、改善前列腺液指标及尿流率方面具有一定疗效。有29个RCT报道了安全性（n=2502）,其中15个报告了随机分组方法,8个为高质量（改良Jadad量表评分≥4分）。结果表明,与对照组比较,部分中医药疗法所致患者下消化道症状更为显著,前列泰片口服与前列安栓塞肛治疗出现了性功能异常。结论现有临床证据表明,中医药治疗前列腺炎在缓解患者症状、改善前列腺液指标及尿流率方面可能具有一定效果。在安全性方面,与对照组比较,部分中医药疗法可引起患者一定程度不良反应。由于本系统评价所纳入研究用药变异性大且时间不同,因此无法进行总体的效应合并分析,对整体效果尚需大量研究支持。     

Use of lamotrigine in glossopharyngeal neuralgia: a case report

We describe a case of a patient with glossopharyngeal neuralgia (refractory to treatment with carbamazepine, amytriptyline, diazepam, and indomethacin) treated with lamotrigine as monotherapy, the first described, who responded completely to the therapy and did not complain of side effects. The complete analgesic effect was reached at the lamotrigine daily dose of 200 mg per day and was maintained at that dose for additional 6 months, with the blood concentration within the reference range.     

Impact of age,weight and concomitant treatment on lamotrigine pharmacokinetics

What is known and Objective: Lamotrigine metabolism may be substantially altered with concomitant administration of valproic acid and/or carbamazepine. Such alterations may require the adjustment of lamotrigine dose to ensure optimal treatment efficacy and safety. Methods: The extent of lamotrigine interactions was investigated dependent on age, gender, weight and dose of concomitant carbamazepine and/or valproic acid in 65 patients with epilepsy. Lamotrigine plasma steady‐state oral clearance (CLss/F) and area under the curve (AUCss) were calculated from the dose of drug, average steady‐state concentration (Css) and interval of administration. Multiple regression analysis was used for the identification and quantification of factors that influenced lamotrigine pharmacokinetics. Results and Discussion: Age and dose of carbamazepine and valproic acid had significant influence on lamotrigine CLss/F and AUCss. Carbamazepine was associated with a dose‐dependent increase and valproic acid with a dose‐dependent decrease of lamotrigine metabolism rate. The effect of carbamazepine was more pronounced. Younger patients were expected to metabolize lamotrigine more rapidly whereas overweight patients may be less susceptible to interactions. Gender had no influence on lamotrigine pharmacokinetics. What is new and Conclusion: The efficacy and safety of lamotrigine may be altered by concomitant administration of carbamazepine and valproic acid. The models developed may be useful for estimating doses of lamotrigine for individual patients to minimize clinically significant interactions. Therapeutic monitoring is advisable when those drugs are used concomitantly.     

通心络胶囊治疗不稳定性心绞痛的Cochrane系统评价的研究方案

背景：通心络胶囊由5种虫类中药组成，主要用于心脑血管疾病。它于2000年获得国家科技进步二等奖，并被列入国家中药基本药物。目的：评价通心络胶囊治疗不稳定心绞痛的疗效和可能的副效。检索策略：电子检索The Cochrane Heart Review Group specialised trials register,The Cochrane Controlled Trials Register,published in the latest issue of the Cochrane Library,MEDLINE,EMBASE,CBM,Chinese Cochrane Centre Controlled Trials Register,Current Controlled Trials(www.controlled-trials.com),The National Research Register。手检：我国83种中医药杂志。资料纳入标准：使用通心络胶囊治疗不稳定性心绞痛的随机和半随机对照试验。结果测量指标为因急性心肌梗死所致的死亡、心绞痛的严重程度、急性心绞痛发作次数、心电图改善程度、硝酸甘油用量和症状改善，等等。资料分析：对符合纳入标准的随机对照试验进行内部真实性评价，如果所有纳入的随机对照试验有足够的质量和相似性，则采用Meta分析。     

Lamotrigine--an effective mood stabilizer?

OBJECTIVE: To review the literature regarding the use of lamotrigine as a mood stabilizer, and to discuss its efficacy in treating this condition. DATA SOURCES: Data were obtained from MEDLINE, Micromedex, and Cochrane collaboration searches from January 1985 to July 1998. DATA SUMMARY: There are insufficient data to confirm that lamotrigine is an effective mood stabilizer. There are no controlled studies, and the current evidence is from case studies and open trials. Furthermore, only one study shows any evidence of effectiveness in the manic phase, although this may be because the data tend to relate to a treatment-refractory population. CONCLUSIONS: From the current evidence, lamotrigine cannot be recommended as a mood stabilizer except when conventional therapies have failed.     

Improved sexual function in three men taking lamotrigine for epilepsy

Little information exists about the effects of newer antiepileptic drugs (AEDs) on sexual function in men with epilepsy. We report a series of three male veterans whose sexual disorders improved with lamotrigine. All three had partial seizures. One patient was taking phenobarbital and gabapentin and complained of decreased potency and anorgasmia. After lamotrigine was added for better seizure control and the dosage of gabapentin was tapered, anorgasmia improved. The second patient complained of impotence after a rash while taking phenytoin and carbamazepine. Impotence persisted with phenobarbital, valproate, and gabapentin. Eight months after gabapentin was replaced with lamotrigine, impotence improved. The third patient complained of long-standing impotence. Treatment with five AEDs had no effect on the dysfunction. Lamotrigine was added to the carbamazepine regimen; impotence improved with decrease in carbamazepine and increase in lamotrigine. The favorable effect of lamotrigine on sexual disorders in these three patients suggests this drug should be considered under appropriate circumstances for men who have sexual dysfunction while taking other antiepileptic agents.     

Seizure disorders in the elderly

Seizure disorders become increasingly common after the age of 60 years and can have a significant impact on functional status. The goal of antiepileptic drug therapy is to control seizures but preserve quality of life. If possible, seizure control should be achieved with one agent given in the lowest effective dosage. Clinical response, rather than drug levels, should guide dosage changes. All antiepileptic drugs can cause dose-dependent sedation and cognitive impairment. Although the newer agents may have theoretical advantages over standard antiepileptic agents, higher cost may limit their use. Drugs for first-line monotherapy of seizures in elderly patients include carbamazepine, valproic acid, oxcarbazepine, gabapentin, and lamotrigine.     

氨氯地平单用及其与ACEI联用治疗成人原发性高血压有效性与安全性的Meta分析

目的 评价氨氯地平单用及其与ACEI 联用治疗成人原发性高血压的有效性与安全性。 方法 电子检索Cochrane 对照试验注册数据库（2009 年第2 期）、PubMed、EMbase、CBM、CNKI（从建库至2009 年8 月）。由两名评价者按纳入与排除标准和Cochrane 协作网推荐的简单评价法选择文献、评价质量,而后对同质研究采用Stata10.0 软件进行Meta 分析。 结果 共纳入17 个RCT,包括3 291 例病人。Meta 分析结果显示：与单用氨氯地平相比,氨氯地平与ACEI 联用能进一步降低收缩压［WMD=5.72,95%CI（4.10,7.33）,P=0.016］和舒张压［WMD=3.62,95%CI（4.85,2.39）,P=0.000］,总不良反应率下降［RR 0.86,95%CI（0.75,0.99）,P=0.034］,其差异有统计学意义。 结论 现有证据表明,氨氯地平与ACEI 联用能进一步降低成人原发性高血压患者血压和不良反应发生率,其有效性和安全性均优于氨氯地平单用。而氨氯地平与ACEI 联用能否降低远期联合心血管事件风险,且组织型ACEI 是否更有优势,则尚需大样本、高质量的随机对照试验来进一步研究。     

Risperidone treatment of bipolar mania

OBJECTIVE: To review clinical trial evidence regarding the efficacy and safety of risperidone for the treatment of bipolar mania. DATA SOURCES: Articles were identified through searches of PubMed (1950-August 2005), EMBASE (1988-August 2005 week 37), and International Pharmaceutical Abstracts (1970-August 2005) databases using the key words risperidone, atypical antipsychotics, and bipolar mania. Additional references were found through review of bibliographies of identified articles. PubMed searches for efficacy and safety were limited to clinical trials. STUDY SELECTION AND DATA EXTRACTION: Six randomized trials and 6 observational studies of risperidone monotherapy or combination therapy for bipolar mania in adults were selected. DATA SYNTHESIS: Randomized, placebo-controlled and observational trials reported that risperidone monotherapy decreases manic symptoms in patients with a moderate severity of mania, as determined by change in Young Mania Rating Scale (YMRS) scores. Adverse effects observed in monotherapy trials included somnolence, extrapyramidal symptoms (EPS), and weight gain. Clinical trials of risperidone in combination with other mood stabilizers (ie, lithium, valproate, carbamazepine, topiramate) also reported decreases in YMRS scores in patients with moderate and severe manic symptoms. CONCLUSIONS: Risperidone monotherapy or adjunctive therapy with other first-line mood stabilizers may be effective for the treatment of acute bipolar mania in adults with moderate severity of mania. The use of risperidone as monotherapy in severe mania or in maintenance treatment remains to be elucidated.     

Anticonvulsants in migraine prophylaxis: a Cochrane review

Several trials have asserted that some anticonvulsant drugs seem to be useful for the prophylaxis of migraine, but systematic reviews are sparse. We independently searched PubMed, EMBASE and the Cochrane Central Register of Controlled Trials until 2005, as well as Headache and Cephalalgia through April 2006, for prospective, controlled trials of anticonvulsant drugs. Data were calculated and pooled across studies and expressed as standardized mean differences, odds ratios and numbers-needed-to-treat. Anticonvulsants, considered as a class, reduce migraine frequency by about 1.3 attacks per 28 days compared with placebo, and more than double the number of patients for whom migraine frequency is reduced by ≥ 50% relative to placebo. Sodium valproate/divalproex sodium and topiramate were better than placebo, whereas acetazolamide, clonazepam, lamotrigine and vigabatrin were not; gabapentin, in particular, needs further evaluation. Trials designed with sufficient power to compare different drugs are also necessary.