卡马西平对癫痫患者血清甲状腺激素的影响

癫痫是神经科的多发与常见病,一旦明确诊断多数患者需长期接受抗癫痛药物治疗。长期服用抗癫痛药物可引起内合泌功能紊乱[1]。为此,我们观察癫痫患者服用卡马西平后甲状腺激素的变化,结果报道如下。对象和方法一、对象：选择1998年9月～1999年1月本院癫痛专科门诊用卡马西平治疗的单纯部分性或复杂部分性发作的癫病患者27例．男16例,女11例．年龄6～27（平均13．7）岁。均为首次诊断为癫捐接受卡马西平治疗的患者。所有患者均无内分泌疾病。卡马西平开始剂量为Ic～15（mg／kg）·d分3次口服,以后根据血药浓度适当调整剂量。对照组27例…     

不同剂量托吡酯联合卡马西平对改善小儿癫痫症状效果分析

目的探讨不同剂量托吡酯联合卡马西平治疗小儿癫痫的临床效果及安全性。方法选取2014年3月至2016年12月本院收治的癫痫患儿103例,随机分为观察组与对照组。对照组患者接受常规剂量托吡酯(6mg·kg~(-1)·d~(-1))联合卡马西平(15mg·kg~(-1)·d~(-1))治疗,观察组患者接受小剂量托吡酯(2mg·kg~(-1)·d~(-1))联合卡马西平(15mg·kg~(-1)·d~(-1))治疗。对比两组患者的临床治疗效果与不良反应发生情况。结果观察组患者治疗3个月癫痫发作减少率大于对照组患者(P0.05)。截止治疗后6个月,2组患者治疗总有效率差异无统计学意义(P0.05),但对照组患者共发生不良反应32例,不良反应发生率为62.75%,显著高于观察组患者的不良反应发生率28.85%(P0.01)。结论小剂量托吡酯联合卡马西平治疗小儿癫痫患者,能够有效改善其临床症状,降低癫痫发作品率,并且减少不良反应发生,有较高的安全性。     

托吡酯对癫痫患者认知功能的影响

目的 评价托吡酯对癫痫病人认知功能的影响。方法 对2001年首次来我院癫痫门诊确诊的26例癫痫患者中12例用托吡酯单药治疗,14例用其他传统的抗痫药物治疗,6个月后对两组对象进行智力测定。托吡酯组还另行测定治疗前后的智力变化。结果 14例用传统抗痫药物治疗组6个月后平均IQ值为(89.64±11.37)分,12例用托吡酯治疗组6个月后平均IQ值为(81.83±17.51)分,两组比较P值<0.05,差别有统计意义;用托吡酯组治疗前智力测定平均IQ值为(87.50±16.78)分,治疗6个月后平均IQ值为(81.83±17.51)分,前后比较P值<0.05,差别也有统计意义。结论应用托吡酯治疗癫痫确实会影响患者的认知功能,使患者的智商(IQ)下降。     

托吡酯长期治疗对成年癫疒间患者血清甲状腺激素水平的影响

目的 探讨托吡酯(TPM)长期治疗对成年癫疒间患者血清甲状腺激素水平的影响.方法 用化学发光分析法测定成年癫疒间组患者(32例)TPM治疗前、后的血清甲状腺激素水平,并与健康对照组(40人)进行比较. 结果治疗前成年癫疒间组患者甲状腺激素水平与健康对照组比较无统计学意义(均P>0.05);TPM治疗后3个月、6个月、12个月及24个月的甲状腺激素水平与治疗前及健康对照组比较差异亦无统计学意义(均P>0.05).结论 TPM短期与长期治疗对成年癫疒间患者的甲状腺激素水平没有影响.     

托吡酯治疗癫痫的临床观察

目的:本文观察应用托吡酯(妥泰)治疗癫痫的效果及安全性。方法:57例癫痫病人给予口服托吡酯,观察不同发作类型、年龄、用药方法、病程长短及影像改变与疗效的关系。结果:托吡酯对部分性、全面性发作及婴儿痉挛均有效,不良反应较轻。结论:托吡酯是一广谱、安全、有效的新型抗癫痫药物。     

托吡酯治疗难治性癫痫的疗效观察

目的：临床临床观察托吡酯（TPM）对难治性癫的疗效和安全性。方法：观察总结21例难治性癫痫病人，在原来应用抗癫痫药物（AEDs）种类及剂量不变的基础上，另增添TPM后3个月与治疗前1个月，癫痫发作频度进行个体自身比较。结果：完全被控制率38．1％，好转率33．3％，总有效率71．4％，不良反应轻微。结论：TPM治疗各类难治性癫痫的疗效显著，安全性好。     

托吡酯添加治疗对难治性癫痫的临床观察

目的 观察添加托吡酯（TPM）对难治性癫痫（IE）的临床效果与安全性。方法 观察IE15例,以加用TPM前1个月的发作频率为基准,按规定添加TPM,并与加TPM后稳定期3个月中最后1个月的发作频率进行比较,比观察疗效,同时观察副作用。以测原用抗癫痫药（AED）治疗前后的血浓度,协助观察患者用药的依从性。结果 患者用药依从性好,有效率为42.1％－46.7％。对多型癫痫发作有效。副反应轻至中度,且多为一过性。结论 加用TMP治疗IE是安全有效的选择方法之一。     

托吡酯对癫痫患者认知功能影响的Meta分析

目的以事件相关电位P300或智商为观察指标运用Meta分析的方法综合评价托吡酯对癫痫患者认知功能的影响。方法通过计算机文献检索,根据纳入和排除标准收集所有关于托吡酯对癫痫患者认知功能影响的研究文献,应用RevMan4.2软件对符合要求的研究结果进行Meta分析。结果共有相关文献8篇纳入分析(托吡酯起始剂量0.5mg/kg/d,维持剂量小于300mg/d)。Meta分析结果表明,癫痫患者应用托吡酯治疗后P300潜伏期显著延长(WMD=-25.60,95%CI[-43.07,-8.14],假设检验z=2.87,P=0.004),P300波幅差异无统计学意义(P=0.30),总智商、语言智商、操作智商得分显著下降(P0.001)。结论托吡酯小剂量、缓慢加量、低维持剂量治疗癫痫,仍能引起认知功能受损。     

托吡酯添加治疗难治性癫痫的临床研究

目的观察托吡酯作为添加药物治疗难治性癫痫的疗效、用药方法、剂量及副作用.方法采用开放性试验的方法对50例难治性癫痫患者(其中成人30例,小儿20例)进行添加托吡酯治疗,观察其疗效.结果托吡酯作为添加药物治疗难治性癫痫,总有效率达58%,22%的患者发作停止.对复杂部分性发作有效率达69%,对其他发作类型亦有一定疗效.本组中成人的疗效好于儿童.平均有效剂量成人为(123.9±47.9)mg/d,小儿为(3.6±1.2)mg·kg     

托吡酯与卡马西平治疗脑梗死后继发癫（癎）患者的疗效比较

目的 比较托吡酯与卡马西平治疗脑梗死后继发癫（癎）的临床疗效.方法 选取2011-05-2013-05我院收治的72例脑梗死后继发癫（癎）患者,采用随机对照方法分为观察组和对照组各36例.对照组在常规治疗基础上应用卡马西平,观察组在常规治疗基础上应用托吡酯,比较2组临床疗效、癫（癎）发作次数及不良反应.结果 观察组总有效率91.7%,对照组为80.6%,观察组总有效率显著高于对照组,差异有统计学意义（P〈0.05）;观察组3个月和6个月内癫（癎）发作次数均显著少于对照组,差异有统计学意义（P〈0.05）.结论 托吡酯治疗脑梗死后继发癫（癎）的临床疗效明显优于卡马西平,可有效降低癫（癎）的发作次数,且不良反应少,值得临床应用和推广.     

卡马西平 托吡酯与丙戊酸钠治疗脑炎继发癫痫的疗效分析

目的观察卡马西平、托吡酯与丙戊酸钠治疗脑炎继发癫痫的疗效。方法选取60例脑炎继发癫痫患者为研究对象,随机分为A、B、C 3组,每组20例,A组给予卡马西平治疗,B组给予丙戊酸钠治疗,C组给予托吡酯治疗。对3组疗效进行评价;对3组患者治疗期间不良反应的发生情况进行观察。结果 3组临床有效率分别为70%、70%和75%,差异无统计学有意义(P0.05),且3组各项疗效评价结果差异均无统计学意义(P0.05);3组治疗期间不良反应的发生率分别为55%、45%和15%,A组或B组不良反应发生率显著高于C组(P0.05),A组皮疹发生率显著高于B组与C组(P0.05)。结论卡马西平、丙戊酸钠、托吡酯治疗脑炎继发癫痫的疗效基本相当,但托吡酯的不良反应较少,有助于提高患者的依从性。     

Effects of topiramate and carbamazepine on thyroid hormone level in adults with epilepsy

BACKGROUND: It has been demonstrated that traditional antiepileptics, such as phenytoin, carbamazepine (CBZ), phenobarbital, etc., can result in the decrease of thyroid hormone of epileptic patients. However, there is still no sufficient evidence for the studies about the effect of new-type antiepileptics, such as topiramate (TPM), on thyroid hormones. OBJECTIVE: To observe the effects of TPM and CBZ on the level of thyroid hormones in serum of adults with epilepsy. DESIGN: A comparative observation. SETTING: Department of Neurology, Sichuan Provincial People's Hospital. PARTICIPANTS: Totally 100 outpatients or inpatients newly diagnosed to have epilepsy were selected from the Department of Neurology, Sichuan Provincial People's Hospital from July 2003 to August 2005, including 60 males and 40 females, aged 18-70 years. All the patients were accorded with the standard for the classification of epilepsy set by International League Against Epilepsy (ILAE) in 1981; Had been Informed and agreed with the detection; Had no history of thyroid gland disease; Had not taken any drugs could affect the thyroid function. Meanwhile, 40 adult healthy examinees were selected from our hospital as the control group, including 24 males and 16 females, aged 18-65 years. METHODS: ① The 100 epileptic patients were randomly divided into TPM group (n =50) and CBZ group (n =50), and they were treated with TPM (Xian-Janssen Pharmaceutical, Ltd.; Batch number: 03AS032, Norm: 25 mg/tablet) and CBZ (Shanghai Sunve Pharmaceutical Co., Ltd.; Batch number: 030201, Norm: 100 mg/tablet) respectively. The initial dosage of TPM was 25 mg per day, increased by 25 mg every week, the objective dosage of 100-200 mg per day was maintained when the symptoms were satisfactorily controlled. The dosage of CBZ was 6-8 mg/kg per day. All the patients were administrated for 1 year. ② The serum levels of total thyroxine (TT4), free thyroxine (FT4), total triiodothyronine (TT3), free triiodothyronine (FT3) and thyroid stimulating hormone (TSH) in the epileptic patients were detected by means of chemiluminescence before treatment and at 3, 6 and 12 months after treatment respectively. ③Standards for judging curative effects: Controlled by without seizure, the frequency of seizure reduced by ≥ 75% was taken as significant effect, reduced by 50%-74% as effect, and reduced by < 49% as invalid, whereas increased by more than 20% was taken as aggravation. ④ The intergroup and intragroup differences of the measurement data were compared by the analysis of variance and paired t test respectively. MAIN OUTCOME MEASURES: Serum levels of thyroid hormones before treatment and at different time points after treatment of TPM and CBZ. RESULTS: All the 100 epileptic patients and 40 healthy subjects were involved in the analysis of results. ① Changes of serum levels of thyroid hormones: The serum levels of TT3, TT4, FT3, FT4 and TSH were close between the epileptic patients and normal subjects before treatment (P > 0.05). In the CBZ group, the serum levels of FT4 at 3, 6 and 12 months after treatment [(16.87±3.77), (16.34±3.98) , (16.97±3.95) pmol/L] were significantly decreased as compared with those before treatment [(18.00±3.54) pmol/L, t =2.74, 3.50, 2.26, P < 0.05]; The levels of TT3 at 3, 6 and 12 months [(2.09±0.54), (1.99±0.49), (1.84±0.47) nmol/L] were significantly decreased as compared with those before treatment [(2.22±0.63) nmol/L, t =2.73, 2.78, 5.18, P < 0.05]. The levels of TT3 at 6 and 12 months [(109.65±23.98), (107.72±23.90) nmol/L] were significantly decreased as compared with those before treatment [(118.98±28.48) nmol/L, t =3.11, 3.30, P < 0.05]. TT4 level in serum at 3 months and the levels of FT3 and TSH at each time point after CBZ treatment had no obvious changes as compared with those before treatment (P > 0.05). In the TPM group, the levels of thyroid hormones at each time point had no obvious changes as compared with those before treatment (P > 0.05). ② Curative effects: Of the 100 epileptic patients, it was controlled in 12 cases, significantly effective in 30 cases, effective in 39 cases and invalid in 19 cases, the total effective rate was 81% (81/100). CONCLUSION: CBZ treatment can lead to the decreases of thyroid hormones in adult epileptic patients. Epilepsy itself and TPM treatment cannot change the thyroid hormones in adult epileptic patients, which suggests that TPM treatment is safer for the thyroid function of adult epileptic patients.     

拉莫三嗪对癫(癎)患者血清甲状腺激素水平的影响

目的 观察拉莫三嗪对癫(癎)患者血清甲状腺激素水平的影响.方法 用化学发光分析法检测51例癫(癎)患者(癫(癎)组)拉莫三嗪治疗前及治疗后3个月、6个月、12个月的血清甲状腺激素水平,并与43名正常对照者进行比较.结果 癫(癎)组患者治疗前血清甲状腺激素水平与正常对照组比较,差异均无统计学意义;拉莫三嗪治疗后3个月、6个月、12个月的甲状腺激素水平与治疗前及正常对照组比较,差异亦均无统计学意义.结论 拉莫三嗪对癫(癎)患者的甲状腺激素水平没有明显影响,安全性好.     

传统抗癫疒间药物与托吡酯对成年癫疒间患者生活质量影响的对比研究

目的 探讨传统抗癫癎药物(AEDs)与托吡酯(TPM)对成年癫癎患者生活质量(QOL)的影响。方法 102例临床确诊的成年癫癎患者随机分为AEDs组和TPM组,井用QOL IE-30表对102例癫癎患者和62名正常人(对照组)进行评定。结果 AEDs组较对照组QOL明显降低(P<0.05),表现惧怕发作,对日常生活不满意,情绪差,精力不足,认知功能下降,对长期服用抗癫癎药物的顾虑较多,社交、工作受限等;而TPM组的QOL虽然低于对照组(P<0.05),但在前5项的评分中明显高于AEDs组(P<0.05)。TPM组的发作频率明显低于AEDs组(P<0.05)。发作频率对癫癎患者QOL的影响较大,癫癎发作越频繁,QOL越差。结论 成年癫癎患者的QOL较正常人显著降低,TPM能提高癫癎患者的QOL,其改善QOL的作用主要是通过控制发作实现的。因此,合适的药物控制癎性发作是提高癫癎患者QOL的关键。     

Time course of adverse events in patients with localization-related epilepsy receiving topiramate added to carbamazepine

PURPOSE: To explore the time course of treatment-emergent adverse events (AEs) during topiramate (TPM) adjunctive therapy. METHODS: Post hoc analyses were performed by using data from a large (264 subjects) multicenter, double-blind, placebo-controlled trial in which 200 mg/day TPM was added to carbamazepine (CBZ) with or without another antiepileptic drug (AED) in adults with treatment-resistant partial-onset seizures. The daily incidence and mean duration of the most common (> or =5% incidence) AEs were calculated for patients completing the 12-week study. RESULTS: The daily incidence of somnolence, headache, loss of appetite, nervousness, fatigue, dizziness, upper respiratory tract infection, and vertigo peaked during titration and declined to rates similar to that of placebo after the target TPM dose had been reached. In contrast, the daily incidence of paresthesia increased during titration and was maintained for the study duration. Relatively few patients had cognitive symptoms (9% with TPM, 5% with placebo), but these were the most common AEs associated with treatment discontinuation. Patient/investigator reports of weight loss increased gradually over the course of the trial, corresponding with the pattern of change in weight measured at study visits. CONCLUSIONS: This study demonstrates that most of the more common AEs with TPM adjunctive therapy are transient. Patients can be counseled that most AEs emerging when TPM is initially added to CBZ can be expected to diminish with continued therapy.     

托吡酯单药治疗各型癫癎的临床研究

目的观察托吡酯单药治疗成人和儿童各型癫癎的临床效果与安全性.方法用开放性试验的方法对34例癫癎患者进行了添加转单药以及首诊单药的托吡酯治疗;以加用托吡酯前3个月的月均发作频率为基准,与单用或转换单用托吡酯进入稳定期后3个月的月均发作频率进行比较,按常规计算发作减少百分比的中位值和有效率百分比.结果托吡酯无论在添加转单药还是单药的治疗上均有明显疗效,且抗谱广,可用于单纯部分性发作有或全面性发作、复杂部分性发作有或全面性发作、婴儿痉挛症,无耐药现象.14岁以上者托吡酯单药治疗的剂量明显低于添加治疗组.托吡酯的副反应以中枢神经系统最常见,但导致治疗中断的副反应尚未见到.结论托吡酯是一个广谱抗癫癎药,疗效肯定,无耐药性,无严重副反应,可用于单药治疗.     

传统抗癫痫药物和妥泰对成年癫痫患者生活质量的影响

目的 评价传统抗癫痫药物和妥泰对成年癫痫患者生活质量的影响。方法 102例临床新确诊的成年癫痫患者被随机分为两组：一组予以传统抗癫痫药物单药系统治疗(AEDs组)，另一组予以妥泰单药治疗(TPM组)。1个月后比较两组的发作频率和不良反应。并用QOLIE-30表对这102例癫痫患者进行生活质量评定。结果 TPM组的发作频率和不良反应均明显低于AEDs组，而生活质量总分明显高于AEDs组，尤其在前五项的评分中更加明显。结论 TPM能提高癫痫患者的生活质量，其改善生活质量的作用主要是通过控制发作和减轻不良反应实现的。     

卡马西平与TRH抗癫痫作用相互关系的研究

目的探讨卡马西平与促甲状腺素释放激素（ＴＲＨ）抗癫痫作用的相互关系。方法采用放射免疫分析法测定戊四氮（ＰＴＺ）急性致病大鼠海马ＴＲＨ的含量。结果急性致痫后,海马内ＴＲＨ表达水平在２小时未见明显变化,４８小时显著升高。卡马西平预处理组在痫性发作后４８小时海马内ＴＲＨ表达水平明显升高,与对照组及假模型组相比均有显著性差异。结论卡马西平能显著升高痫性发作对ＴＲＨ的诱导表达,ＴＲＨ与卡马西平的作用可能有重