鼠神经生长因子联合抗癫痫药物治疗小儿难治性癫痫的疗效及安全性

目的 观察鼠神经生长因子联合抗癫痫药物治疗小儿难治性癫痫的疗效及安全性.方法 选取2017年10月-2019年4月沈阳市儿童医院收治的小儿难治性癫痫患儿176例,按照入院前后顺序随机分为观察组和对照组,每组88例.对照组给予常规抗癫痫药物左乙拉西坦联合卡马西平治疗,观察组在对照组基础上予注射用鼠神经生长因子治疗.比较2...     

抗癫痫药物鼻腔给药治疗癫痫发作研究进展

以全身疾病为治疗目的的鼻腔给药具有相对生物利用度高、吸收迅速、起效快、使用方便等特点,而且药物可以绕过血脑屏障、具有一定的脑靶向性,非常适合于癫痫发作的急救、自救治疗。笔者就抗癫痫药物鼻腔给药治疗癫痫发作的研究进展,从药物动力学、药效学、临床应用等方面进行综述。     

夜间给予不同剂量抗癫痫药治疗清晨或夜间癫痫发作患儿的疗效观察

目的：探讨针对清晨或夜间癫痫发作患儿,夜间给予其不同剂量抗癫痫药治疗的临床效果。方法：将60例清晨或夜间癫痫发作患儿,按入院时间随机分为观察组与对照组各30例。2组患儿给予抗癫痫药丙戊酸钠治疗,初始剂量为10 mg／（ kg?d）,按照每周5～10 mg／（kg?d）的剂量逐渐增加,直至有效维持剂量[20～30 mg／（kg?d）],均1日给药2次,按照日常作息时间服药（分别为夜间睡觉前1 h和清晨）,2次服药的时间需间隔12 h。对照组患儿夜间给药剂量与清晨给药剂量相同,观察组患儿夜间给药剂量则为对照组的2倍。对比观察2组患儿的疗效与不良反应。结果：治疗3个月后,观察组患儿的总有效率为90．00％（27／30）,略高于对照组的86．67％（26／30）,差异无统计学意义（P＞0．05）;治疗6个月后,观察组患儿的总有效率为86．67％（26／30）,明显优于对照组的60．00％（18／30）,差异有统计学意义（P＜0．05）。观察组患儿的不良反应发生率略低于对照组,差异无统计学意义（ P＞0．05）。结论：针对清晨或夜间癫痫发作的患儿,在夜间给予较大剂量的抗癫痫药（丙戊酸钠）治疗,可明显控制患儿的癫痫发作情况,降低不良反应发生率,临床效果较好,值得推广。     

小儿难治性癫痫的外科治疗及术前评估

癫痫是一种危害性较大的神经系统常见病,儿童癫痫的患病率1% ～2%.由于抗癫痫药物(antiepileptic drugs AEDs)的应用,大多数癫痫患儿能得到满意的控制,但仍有近30%的患儿因药物治疗无效而发展为难治性癫痫.     

应用不同抗癫痫药治疗儿童癫痫与肥胖的关系

目的　了解应用不同抗癫痫药 (AEDs)所导致癫痫患儿肥胖的情况。方法　根据患儿服用的不同AEDs,将 6 6例癫痫病人分为丙戊酸钠治疗组和非丙戊酸钠治疗组两组 ,对其体重 (Wt)及身高 (H)从服用AEDs开始进行为期 6个月的观察 ,观察肥胖指标 (BMI)的变化情况。结果　丙戊酸钠治疗组从治疗后 3个月开始出现肥胖 ,到治疗后 6个月时 ,男、女性的肥胖指标才有统计学的差异 ;丙戊酸钠治疗组的肥胖指标与非丙戊酸钠治疗组的统计学差异 ,也是从治疗后 3个月开始。结论　应用丙戊酸钠后可导致癫痫病人出现肥胖 ,其肥胖发生的时间一般在开始应用此药治疗后 3个月 ,因此 ,临床上应用丙戊酸钠时 ,要注意导致癫痫病人出现肥胖的问题。     

小儿难治性癫痫持续状态20例疗效分析

目的探讨小儿难治性癫痫持续状态的治疗方法及预后。方法对20例小儿难治性癫痫持续状态的治疗方法及预后进行分析。结果苯妥英钠、苯巴比妥、利多卡因对惊厥发作控制率相近,而硫喷妥钠的控制率明显较高。虽多数患儿最终发作缓解,但预后较差。结论对于难治性癫痫持续状态的治疗应熟悉各种常用抗惊厥药物的药理特性,治疗前应制定合理的治疗方案,以提高惊厥发作的控制率和患儿的生存率。     

新型和传统抗癫痫药物治疗新诊断部分性癫痫的临床研究

目的:比较新型和传统抗癫痫药(AEDs)治疗新诊断部分性癫痫患者的疗效及安全性。方法:收集新诊断部分性癫痫患者的临床资料,分为卡马西平(carbamazepine, CBZ)组、左乙拉西坦(levetiracetam, LEV)组、奥卡西平(oxcarbazepine, OXC)组和拉莫三嗪(lamotrigine, LTG)组,以治疗后稳定期初次发作时间、治疗失败时间和达“6月、1年和2年无发作”比例为观察指标,评估其治疗癫痫的有效性及安全性。结果:本研究共收集250例新诊断部分性发作癫痫患者,分为CBZ组(n=62)、LEV组(n=67)、OXC组(n=63)、LTG组(n=58)。通过Kaplan-Meier统计分析显示新型和传统AEDs治疗癫痫后初次发作时间,CBZ和OXC的疗效相当(Log-Rank=0.226,P=0.635),而CBZ优于LTG(Log-Rank=15.305,P=0.000)和LEV(Log-Rank=8.027,P=0.005);治疗失败时间,CBZ和LTG疗效相当(Log-Rank=0.127,P=0.721),而CBZ优于OXC、LEV,差异均具有...     

妥泰单药治疗小儿原发性癫痫发作的疗效及不良反应分析

目的探讨妥泰单药治疗小儿原发性癫痫发作的疗效及不良反应。方法对我院收治的76例原发性癫痫儿童实施妥泰单药治疗,逐渐加大药量,病情明显控制后不再加量;比较治疗前后效果。结果 76例儿童中,无发作为13例(17.1%),显效为35例(46.1%),有效为24例(31.5%),总有效率达94.7%,与治疗前相比具有显著差异(P<0.05),具有统计学意义;有23例患者出现不同程度的体质量下降、头晕、发热等不良反应调整用药后逐渐好转或消失,76例服用妥泰后无因不良反应停药。结论妥泰单药治疗小儿原发性癫痫发作效果良好,不良反应轻微,可以在临床上大力推广。     

The effect of epilepsy and antiepileptic drugs on sexual,reproductive and gonadal health of adults with epilepsy

Epilepsy is a common chronic medical illness. Hyposexuality is the most frequent abnormality in men and women with epilepsy. In men with epilepsy, hypoandrogenimia, hypogonadism and sperm abnormalities are common. Testicular atrophy was also infrequently reported. In women with epilepsy, hyperandrogenism, polycystic ovaries (PCOs) and PCO syndrome are frequent. Decreased serum free testosterone, dehydroepiandrosterone levels, free androgen index and free testosterone/leutinizing hormone (LH) ratio and increased sex hormone binding globulin, estradiol, prolactin, LH, follicle stimulating hormone (FSH) levels and LH/FSH ratio are common with epilepsy. Disturbance of central and/or peripheral control of hypothalamic-pituitary-gonadal axis and alteration of central neurotrasmitters (GABA, glutamate and serotonin) by epileptic discharges or antiepileptic drugs (AEDs), direct gonadal toxicity by AEDs and pcyshicatric/psychosocial factors are all incriminated in sexual, reproductive and gonadal abnormalities associated with epilepsy. Patients may benefit from multidisplinary evaluation, tight seizure control, change the AED, androgen therapy, genital vasodilators, L-carnitine supplementation and psychotherapy.     

醒脑静静脉注射联合左乙拉西坦治疗癫痫患者的疗效观察及对甲状腺功能的影响

目的 探讨醒脑静静脉注射联合左乙拉西坦治疗癫痫患者的疗效及对甲状腺功能的影响.方法 76例癫痫患者随机分为联合组与对照组,各38例.联合组采用醒脑静静脉注射联合左乙拉西坦治疗,对照组仅采用左乙拉西坦治疗.对比分析两组治疗总有效率,治疗前后血清NSE、MMP-9、甲状腺功能指标及不良反应.结果 联合组治疗总有效率(94.73％)明显高于对照组(78.95％)(P＜0.05);联合组和对照组治疗后血清NSE和MMP-9水平明显低于治疗前,且联合组治疗后血清NSE和MMP-9水平低于对照组,差异有统计学意义(P＜0.05);两组治疗前后甲状腺功能指标水平变化比较差异无统计学意义(P＞0.05);两组均未见严重不良反应.结论 醒脑静静脉注射联合左乙拉西坦对癫痫患者疗效显著,但对甲状腺功能无明显影响,可明显降低患者血清NSE和MMP-9表达.     

根管-塑化联合治疗中老年人磨牙牙髓和根尖周病的疗效观察

目的：探讨根管-塑化联合治疗中老年人磨牙牙髓病和根尖周病的临床疗效。方法：选取336例中老年人患有不可复性牙髓炎、牙髓坏死、牙髓钙化、牙内吸收和急、慢性根尖周炎的患牙358颗,随机分为对照组和实验组,对对照组行常规根管治疗,对实验组则根据每个牙齿各根管的不同情况,采用根管-塑化联合治疗,观察2年进行临床评价。结果：对照组的治愈率为90．0％,实验组的治愈率为91．4％,对照组和实验组治愈率的差异无统计学意义（P〉0．05）。结论：根管-塑化联合应用是治疗中老年人磨牙牙髓病和根尖周病的一种简便、有效的治疗方法,值得推广应用。     

Safety of 25- and 50-mg capsules in the initiation of zonisamide therapy in patients with epilepsy: an uncontrolled,open-label study

SUMMARY

Objective: This study was designed to assess the safety of 25- and 50-mg dosage strengths of zonisamide for initial titration in patients with epilepsy.

Research design and methods: This phase 3, multicenter, open-label, uncontrolled study conducted at 26 study sites in the United States included male and female patients with epilepsy ≥ 12?years of age. After a screening visit, subjects began zonisamide therapy at a dosage depending on their body weight. Zonisamide was titrated to 100?mg/day.

Main outcome measures: At the study's conclusion, information regarding adverse events (AEs) and body weight was recorded.

Results: One hundred forty-three subjects enrolled and received at least one zonisamide dose. Of these subjects, 125 reached at least the 100-mg dosage before terminating the study. Eighty-two subjects (57.3%) experienced at least one AE. Most commonly reported AEs included headache, somnolence, asthenia, rhinitis, nausea, and rash. No significant change in patient body weight was noted during the study (95% confidence interval: –0.1, 0.6).

Conclusions: Study limitations include the open-label design and the lack of direct comparison between lower (25- and 50-mg) and higher (100-mg) starting dosages. Despite these limitations, the 25- and 50-mg zonisamide dosage formulations were well tolerated in this study.     

药物联合饮食控制、运动疗法治疗45侵社区糖尿病的疗效分析

目的探讨社区糖尿病患者应用饮食控制、运动疗法辅助药物治疗效果。方法本研究随机抽取本社区2008年3月～2010年3月期间90例确诊为糖尿病患者作为研究对象,经患者及医院伦理委员会同意将其分为2组,每组45例,对照组患者单纯提供药物治疗,治疗组患者在此基础上使用饮食控制、运动疗法等辅助治疗,持续6个月,观察两组患者空腹血糖（FPG）、餐后2h血糖（2hPG）、体重指数（BMI）等指标的变化情况,评价其疗效。结果治疗组患者经过6个月治疗后各项观察指标均显著改善（P〈0．05）;治疗组显效率、总有效率分别为71．11％、97．78％,明显高于对照组46．68％、84．44％（P〈0．05）。结论糖尿病患者药物治疗基础上辅以饮食控制、运动疗法能显著降低患者血糖、体重指数,有助于延缓和减少并发症的发生,促进治疗效果,值得在社区治疗过程中广泛推广和应用。     

复合辅酶对婴儿肝炎综合征肝功能、心功能影响临床研究

目的研究用复合辅酶治疗婴儿肝炎综合征时患儿肝功能、心功能的变化及临床效果。方法105例IHS患儿随机分为治疗组55例（男28例,女27例;平均年龄2．35个月）与对照组50例（男26例,女24例;平均年龄2．05个月）。二组病例均予保肝及基础治疗。治疗组在此基础上,加用注射用复合辅酶针（100u／次,17．X／d）,连续应用14d为1个疗程,部分用2、3疗程。监测二组患儿治疗前后血清中总胆红素（TB）、结合胆红素（DB）、ALT、γ-谷氨酰转肽酶（γ-GT）、总胆汁酸（TBA）水平、肝脏大小及CK、CKMB、LDH、HBDH、心电图变化。采用SPSS11．0软件进行统计学分析。结果采用注射用复合辅酶治疗2周后,治疗组患儿血清中TB（88．5±11．9μmol／L）、DB（41．7±13．5μmol／L）、AUr（72．3±6．5U／L）、γ-GT（315．±126IU／L）、TBA（69．3±15．6μmol／L）、CK（75．2±16．5U／L）、CKMB（12．6±2．7U／L）、LDH（154．7±23．8U／L）、HBDH（301．5±16．8U／L）与对照组比较均有明显下降,有显著性差异（P〈0．01）,肝脏明显缩小（P〈0．01）,心电图明显恢复正常;二组均未见明显药物不良反应。结论复合辅酶能降低血清胆红素及内源性胆汁酸水平,可促进胆红素、TBA排泄,具有明显的利胆、退黄作用,同时可保护心肌,促进心肌细胞功能恢复。     

Evaluation of health status in epilepsy using the EQ-5D questionnaire: a prospective,observational, 6-month study of adjunctive therapy with anti-epileptic drugs

ABSTRACT

Aims: The aims of this project were to evaluate the impact of adjunctive treatment with an anti-epileptic drug (AED) on the health status of people with epilepsy and to investigate how seizure frequency affects their health status.

Methods: Adult epilepsy patients, refractory to current treatment, were included in this prospective observational study. Patients commencing adjunctive therapy with one of five AEDs (topiramate, lamotrigine, gabapentin, clobazam, vigabatrin) were eligible for inclusion. The study took place at the outpatient clinics of the National Hospital for Neurology and Neurosurgery, Queen Square, London. Patients completed the EQ-5D, a generic health status measure, at baseline and again after 3 and 6 months. Information was also collected on medications and seizure frequency.

Results: In total, 125 patients entered the study and were followed up for 6 months. Patients treated with topiramate had a significant increase (?p < 0.05) in EQ-5D score from baseline, indicating an improvement in their health status whereas scores for lamotrigine, clobazam and gabapentin all showed a non-significant decline. When the data were analysed according to seizure frequency, only patients who became seizure-free on adjunctive treatment had a significant increase in their health status. The group who had a 50% reduction in seizure frequency did not have increased health status.

Conclusions: In summary, adjunctive treatment with topiramate significantly increased health status as measured by the EQ-5D. These data also suggest that achievement of seizure-freedom is the key to improving health status in this patient group.     

低频电穴位刺激治疗便秘型肠易激综合征 32例

目的 探讨低频电穴位刺激治疗便秘型肠易激综合征(IBS-C)的疗效.方法 选取2019年2月至2020年2月济宁医学院附属医院兖州院区收治的IBS-C病人64例,采用随机数字表法分为对照组和观察组,每组各32例.对照组给予药物治疗,在此基础上观察组给予低频电穴位刺激治疗,治疗时间为7d.比较两组临床疗效及治疗前后临床症状、心理状态、生活质量.结果 观察组总有效率(90.63％)显著高于对照组(68.75％)(P<0.05).治疗7 d后观察组腹痛/腹部不适、腹胀、排便过程异常、排便性状异常评分及总积分均显著低于对照组(P<0.05);治疗7 d后观察组SAS评分及SDS评分均显著低于对照组(P<0.05);治疗7d后观察组一般健康状况、情感职能、社会功能、精神健康及精力评分均显著高于对照组,躯体疼痛评分显著低于对照组(P<0.05).结论 电穴位刺激治疗IBS-C的临床疗效显著,可改善病人临床症状、负性情绪及生活质量,值得临床推广使用.