卡马西平联合宁痫丹治疗癫痫的临床观察

目的 观察卡马西平联合宁痫丹治疗癫痫的临床疗效及安全性.方法 将42例癫痫患者随机分为治疗组和对照组.对照组服用卡马西平,13岁儿童～成人0.2g/次,3次/d,6～12岁儿童10～20 mg/(kg·d-1),分3次服用;治疗组服用卡马西平的用法及用量同对照组,另外治疗组患者口服宁痫丹,6岁患儿3丸/d,7～10岁4～6丸/d,10～14岁6～9丸/d,15岁～成人9～12丸/d,分3次服用.两组均持续治疗3个月.治疗结束后,观察两组患者临床疗效、癫痫发作次数、治疗前后脑电图异常情况.结果 两组治疗后癫痫发作次数、脑电图异常与治疗前比较差异均有统计学意义(P＜0.05),治疗组和对照组总有效率分别为95.24％、66.67％,两组比较差异有统计学意义(P＜0.05).结论 卡马西平联合宁痫丹治疗癫痫可减少患者癫痫发作次数,且不良反应较少,值得临床推广.     

卡马西平联合中药治疗外伤性癫痫临床疗效对比研究

目的 研究卡马西平联合中药治疗外伤性癫痫的临床疗效.方法 选择126例外伤性癫痫患者为研究对象,随机分配为实验组和对照组各63例,对照组单纯采用卡马西平进行治疗,实验组采用卡马西平联合中药治疗,疗程4个月,观察两组患者的治疗效果.结果 两组外伤性癫痫患者治疗4个月后,实验组总有效率（93.7％）明显高于对照组总有效率（77.8％）,两组疗效差异具有统计学意义（x 2=23.63,P＜0.05）.治疗后,两组患者癫痫的发作频率和发作持续时间相较于治疗前均有明显改善,但差异无统计学意义（P＞0.05）.实验组通过治疗后癫痫的发病时间明显缩短（t=2.47,P＜0.01）;对照组通过治疗后癫痫的发病时间明显缩短（t=2.40,P＜0.01）.治疗后实验组患者癫痫发作频率的改善效果明显优于对照组,两组比较差异具有统计学意义（t=2.13,P＜ 0.05）,治疗后两组患者的发作持续时间比较,差异具有显著的统计学意义（t=2.15,P＜0.05）.治疗过程中,两组患者不良反应发生率经统计差异无统计学意义（P＞0.05）.结论 卡马西平联合中药治疗外伤性癫痫具有更好的临床疗效,并且安全可行,可以起到事半功倍的疗效,值得临床上大力推广应用.     

卡马西平治疗阵发性癫痫的临床疗效观察和体会

目的分析卡马西平用于治疗阵发性癫痫的疗效。方法收集阵发性癫痫患者60例,随机分为治疗组与对照组,各组30例,对照组予以常规抗癫痫药物苯妥英钠进行治疗,观察组在对照组的基础上应用卡马西平进行治疗。结果治疗组的治疗总有效率显著高于单纯应用苯妥英钠治疗的对照组,治疗后癫痫发作频率以及发作持续时间均显著低于对照组,且不良反应率显著低于对照组,P<0.05。结论卡马西平片用于治疗阵发性癫痫疗效显著,安全可靠,值得推广应用。     

尼莫地平辅助卡马西平治疗癫痫

目的：研究不同剂量尼莫地平辅助治疗癫痫的疗效。方法：９２例癫痫病人，男性５４例，女性３８例，年龄（２９± ｓ ７） ａ， １８～５７ ａ，在卡马西平治疗至少３ｍｏ后，随机分为２组添加尼莫地平治疗。大剂量组（４６例）口服尼莫地平 ６０ ｍｇ， ｑ ６ ｈ；小剂量组（４６例）口服尼莫地平 ２０ ｍｇ， ｑ ８ ｈ，共 ３ ｍｏ。结果：大剂量组每人癫痫发作次数明显减少［治疗前（ １７ ± ７）次；治疗后（８±６）次， Ｐ＜ ０． ０１］，总有效率４６％。小剂量组每人癫痫发作次数明显减少［治疗前（１８±８）次；治疗后（６±６）次，Ｐ＜０．０１］，总有效率１７％。大剂量组与小剂量组每月发作次数比较差异有非常显著意义（ Ｐ＜ ０． ０１）。结论：尼莫地平辅助治疗癫痫有效，口服 ６０ ｍｇ， ｑ ６ ｈ疗效较好。     

卡马西平治疗儿童癫痫的血药浓度监测与合理用药

目的：研究儿童癫痫患儿服用卡马西平后,其血药浓度,给药剂量及给药时间的关系。方法：对服用卡马西平及联合用其他抗癫痫药物的51例癫痫患儿,用荧光偏振免疫法（FPIA）监测其血药浓度,并结合疗效进行统计分析。结果：稳态血药浓度与给药剂量,给药时间,是否联合用药等有着密切的关系。结论：儿童癫痫患者服用卡马西平后的血药浓度个体差异大,及时监测血药浓度,调整给药剂量及给药时间,对控制儿童癫痫发作有重要意义。     

卡马西平联合中药治疗外伤性癫痫临床疗效观察

目的观察卡马西平联合中药治疗外伤性癫痫的临床疗效。方法对2010年4月至2011年4月收治的64例外伤性癫痫患者随机分为对照组和观察组各32例,对照组给予卡马西平治疗,观察组给予卡马西平联合中药治疗,观察两组治疗效果。结果两组患者治疗效果比较,观察组治疗总有效率明显优于对照组情况,差异有统计学意义（P〈0．05）。两组不良反应发生率的比较无明显的差异（P〉0．05）。结论卡马西平联合中药治疗外伤性癫痫是可行的,具有较好的临床治疗效果,值得临床应用与推广。     

左乙拉西坦与卡马西平治疗高血压脑出血后癫痫的疗效对比分析

目的:通过对左乙拉西坦与卡马西平治疗高血压脑出血后癫痫的疗效对比分析,评价两者疗效的差异.方法:选取在本院门诊和住院部治疗的148例患者,分为左乙拉西坦组和卡马西平组,随访半年后观察两组癫痫发作控制情况;同时行动态脑电图检查了解放电情况.结果:左乙拉西坦组治疗总有效率为92.86%;卡马西平组治疗总有效率为80.77%,左乙拉西坦组治疗总有效率显著优于卡马西平组(X2=4.177,P=0.043,P<0.05);左乙拉西坦组动态脑电图检查异常率明显低于卡马西平组,差异有统计学意义(X2=4.255,P=0.041,P<0.05).结论:左乙拉西坦对于高血压脑出血后癫痫控制率明显高于卡马西平,治疗后异常放电率更低,值得临床推广.     

研究卡马西平和奥卡西平治疗颞叶癫痫的不良反应分析

目的:评估对颞叶癫痫施予奥卡西平、卡马西平两种药物进行治疗的不良反应情况.方法:选择2015年2月-2016年2月进入本院接受相应治疗的颞叶癫痫患者104例,随机将其划分成对照、分析两组,各有52例,对照组予以卡马西平进行治疗,分析组予以奥卡西平进行治疗,对比两组不良反应的出现率情况.结果:分析组共有4例出现了不良反应,占比7.69％(4/52),对照组共有13例出现了不良反应,占比25.00％(13/52).实验组出现不良反应的病例数、程度都优越于对照组,且组间差异显著(P＜ 0.05).结论:选用奥卡西平对颞叶癫痫实施治疗的不良反应出现率、症状程度都优越于卡马西平的治疗情况.     

Intravenous carbamazepine for the treatment of epilepsy

Introduction: Recently, an intravenous formulation of carbamazepine (CBZ) (sulphobutylether-7-beta-cyclodextrine carbamazepine, SBECD CBZ) has been developed and approved by the U.S. Food and Drug Administration. It is indicated as a short-term replacement therapy for oral CBZ formulations, when oral administration is temporarily not feasible and in adults with focal seizures with complex symptomatology as well as generalized tonic-clonic seizures and mixed seizure patterns.

Areas covered: This review focuses on the drug development, pharmacokinetics and pharmacodynamics of intravenous CBZ and provides a comprehensive overview of the studies assessing its clinical efficacy, tolerability and safety in adults with epilepsy.

Expert opinion: Intravenous CBZ has favorable pharmacokinetics and is well tolerated and safe when used as a short-term substitution for oral CBZ. Seizure control was unchanged after switching from oral to IV formulations. Overall, this new formulation represents a useful option to enhance continuity of care in adults with focal or generalized tonic-clonic seizures when oral CBZ administration is temporarily unfeasible. Further studies are needed to assess the efficacy and tolerability of IV CBZ used at larger doses (above 1600 mg/day), for a period longer than 7 days or for other indications not approved by FDA, such as prolonged convulsive seizures and status epilepticus.     

托吡酯与卡马西平对照治疗成人癫痫133例

目的:比较托吡酯(TPM)及卡马西平(CBZ)单药治疗新诊断的部分性发作成人癫痫患者的疗效及耐受性.方法:133例患者入组,自愿选择进入TPM组58例和CBZ组75例.起始剂量TPM 25mg·d-1,nd,CBZ100mg·d-1,bid.根据患者的发作情况及是否发生不良反应调整剂量,并充分观察该剂量下的疗效及耐受性,以达最佳或最终剂量.通过比较两组患者治疗前后的月平均发作次数变化和因不良反应退出试验的病例比例评价药物的总体疗效.结果:观察时间TPM组(8.10±6.35)个月,CBZ组(15.69±10.23)个月.最佳或最终剂量范围TPM组50～300mg·d-1,CBZ组100～600mg·d.按照发作频率减少≥50%、无效或发作增加、因不良反应退出试验分级,两组比较差异有显著性,两组总有效率分别为75.9%及68.0%(P=0.033 6),因不良反应退出比例TPM组明显低于CBZ组(1.7%vs 14.7%).结论:TPM单药治疗成年新诊断部分性发作癫痫患者的疗效与CBZ相当,安全性和耐受性明显优于CBZ.     

奥卡西平和卡马西平对成人部分性癫痫认知功能及脑电图的影响

目的比较奥卡西平和卡马西平对成人部分性癫痫患者认知功能及脑电图的影响。方法符合诊断标准的成人部分性癫痫患者,随机分为卡马西平治疗组(n=64)和奥卡西平组(n=92),进行单药治疗。分别于治疗前及治疗后6个月行认知功能测评及长程视频脑电图(VEEG)检查。分析2组治疗前后认知功能及脑电图的变化。结果部分性癫痫患者经奥卡西平或卡马西平单药治疗6个月后,韦氏成人智力量测评提示奥卡西平组认知功能较治疗前有所改善,卡马西平组治疗前后变化不明显;脑电图检查示治疗6个月后,奥卡西平组有73.9%的患者癫痫样放电减少超过50%,卡马西平组只占53.1%,2组差异有统计学意义(P<0.05);卡马西平组治疗后α功率值较治疗前显著降低(P<0.05),θ功率值显著增加(P<0.05),奥卡西平组治疗前后α功率值无明显改变(P>0.05),θ功率值明显增加(P<0.05)。结论奥卡西平与卡马西平相比,对成人部分性癫痫患者认知功能改善更明显,对痫样放电的抑制作用较强,且对脑电背景活动影响较小     

Plasma levels of carbamazepine and carbamazepine-10,11-epoxide during treatment of epilepsy

Summary Carbamazepine and its epoxide in plasma were measured by liquid chromatography in 25 patients treated with a mean dose of carbamazepine of 12.5±3.3 mg/kg body weight. The mean concentrations of parent drug and metabolite were 5.4±2.5 µg/ml and 1.10±0.42 µg/ml, respectively. A significant correlation was found between the plasma concentrations of the two compounds (r=0.64; p<0.001), but marked interindividual variation existed in the ratio of carbamazepine to epoxide. Based on simultaneous measurements in plasma and cerebrospinal fluid, the unbound fraction of carbamazepine in plasma was of the order of 20% as compared to 45% for the epoxide. Thirteen ambulant patients suffering from partial epilepsy with complex symptomatology, who were already being treated with phenytoin in optimal doses (plasma level 14–20 µg/ml) were also given carbamazepine. At plasma levels of the latter of about 5 µg/ml there was no further reduction in the frequency of partial or generalized epileptic seizures. In five patients the dose was increased to produce plasma concentrations of 7 – 8 µg/ml. There was still no improvement and side-effects were seen in three patients.     

奥卡西平和卡马西平治疗脑卒中后继发性癫痫疗效与安全性的Meta分析

目的 系统评价奥卡西平与卡马西平治疗脑卒中后继发性癫痫的疗效和安全性。方法 计算机检索PubMed、Cochrane Library、EMbase、万方、中国知网、维普、中国生物医学文献数据库（CBM）等收录的奥卡西平和卡马西平治疗脑卒中后继发性癫痫的相关文献,检索时限为建库以来到2017年8月,使用RevMan5.3软件进行Meta分析。结果 共纳入6项研究,包含517例患者。Meta分析结果显示：奥卡西平组控制癫痫的总体有效率高于卡马西平组,差异有统计学意义（RR=1.44,95%CI：1.29~1.60,P<0.000 01）;奥卡西平组总不良反应发生率低于卡马西平组,差异有统计学意义（RR=0.39,95%CI：0.26~0.57,P<0.000 01）;皮疹、头晕、嗜睡、恶心、呕吐发生率的比较差异均无统计学意义。结论 奥卡西平治疗脑卒中后继发性癫痫的疗效优于卡马西平,安全性较卡马西平好。由于本研究纳入的文献数量和样本量较少,因此还需更多大样本、多中心的高质量临床随机对照试验（randomized controlled trials,RCT）进一步研究验证。     

Time course of the increase in 4beta-hydroxycholesterol concentration during carbamazepine treatment of paediatric patients with epilepsy

AIMS

To investigate the time course of the increase in 4β-hydroxycholesterol and carbamazepine plasma concentrations during treatment of paediatric patients with epilepsy.

METHODS

Eight paediatric patients with newly diagnosed epilepsy were studied. Blood samples were drawn before and after about 1, 2, 4, 8 and 16 weeks of carbamazepine treatment. The plasma concentrations of 4β-hydroxycholesterol were determined by gas chromatography–mass spectrometry and carbamazepine and its epoxide metabolite by high-performance liquid chromatography.

RESULTS

The basal plasma concentrations of 4β-hydroxycholesterol showed a large range of observed values between 18 and 99 ng ml⁻¹. Carbamazepine treatment increased mean plasma 4β-hydroxycholesterol significantly already after 1 week of treatment (from 43 to 80 ng ml⁻¹, P < 0.001). 4β-Hydroxycholesterol concentrations continued to increase until at least 8 weeks of treatment and the concentrations in the final samples (8–23 weeks of treatment) varied between 122 and 494 ng ml⁻¹. Plasma concentrations of carbamazepine and its epoxide metabolite reached steady state at 1–2 weeks after last dose change.

CONCLUSIONS

Carbamazepine treatment of paediatric patients with epilepsy resulted in an induction of CYP3A4/5 and a concomitant increase in plasma 4β-hydroxycholesterol. Whereas the induction of CYP3A4/5 was apparently complete after 1–2 weeks, the increase in 4β-hydroxycholesterol continued for several weeks. Thus CYP3A4 activity is not the only determinant of the circulating level of 4β-hydroxycholesterol. Additional factors such as transport and storage or presence of another enzyme may thus be of importance.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• CYP3A4 converts cholesterol into 4β-hydroxycholesterol.
• We have suggested that 4β-hydroxycholesterol could be used as a clinical marker for CYP3A4 activity aiding in dose adjustments.
• The kinetics of 4β-hydroxycholesterol formation is not known, however, and must be determined in order to establish under what conditions 4β-hydroxycholesterol can be used as a CYP3A marker.

WHAT THIS STUDY ADDS

• The concentration of 4β-hydroxycholesterol increases very slowly during CYP3A4/5 induction in paediatric patients.
• Whereas induction of CYP3A4/5 was apparently complete within 1–2 weeks of carbamazepine treatment, plasma 4β-hydroxycholesterol levels continued to increase until at least 8 weeks of treatment.

     

卡马西平和托吡酯联合治疗复杂部分性癫痫29例

目的观察卡马西平和托吡酯联合治疗复杂部分性癫痫的临床疗效及安全性.方法对29例患儿在单用卡马西平治疗的基础上,加用托吡酯联合治疗.结果加用托吡酯后疗效明显,总有效率达69%,发作完全控制率占38%.结论研究结果表明,两药联合治疗复杂部分性癫痫是安全有效的.     

卡马西平与托吡酯在针对部分性癫痫患者的有效性及安全性分析

目的 分析卡马西平与托吡酯在针对部分性癫痫患者的有效性及安全性.方法 搜集2009年2月至2013年3月于我院住院治疗的部分性癫痫患者72例,随机将患者分为联合治疗组(36例)和卡马西平组(36例),观察分析联合治疗组和卡马西平组用药后3个月、6个月部分性癫痫发作率、发作频率,用药后6个月的临床疗效,用药后6个月脑电图随访及不良反应.结果 联合治疗组治疗后3个月发作率为33.33％,发作频率为(2.57±2.09)次;联合治疗组治疗后6个月发作率为22.22％,发作频率为(2.21±1.73)次.卡马西平组治疗后3个月发作率为47.22％,发作频率为(3.69±2.73)次;卡马西平组治疗后6个月发作率为33.33％,发作频率为(3.52±2.27)次.联合治疗组治疗后3个月及6个月的部分性癫痫发作率及发作频率均显著低于卡马西平组(P＜0.05).联合治疗组用药6个月后治疗有效率为86.11％;卡马西平组治疗6个月后治疗有效率为72.22％,联合治疗组用药6个月后治疗有效率显著高于卡马西平组(P＜0.05).联合治疗组痫样放电改善率为80.00％,卡马西平组痫样放电改善率为69.56％,联合治疗组痫样放电改善率高于卡马西平组(P＜0.05).联合治疗组不良反应发生率为16.67％,卡马西平组不良反应发生率为13.89％,两组患者不良反应发生率差异无统计学意义(P＞0.05).结论 卡马西平联合应用托吡酯能够有效地治疗部分性癫痫,且安全性较高.