丙戊酸钠联合托吡酯对部分发作性癫痫患儿的临床疗效分析

目的探讨丙戊酸钠联合托吡酯对部分发作性癫痫患儿脑电图及血清神经元特异性烯醇化酶(NSE)、同型半胱氨酸(Hcy)、神经肽Y(NPY)的影响。方法选取2017-01—2019-12南阳中心医院诊治的102例部分发作性癫痫患儿,随机分为2组。分别给予丙戊酸钠联合托吡酯治疗(联合组,53例)和丙戊酸钠治疗(单药组,49例)。对比2组治疗3个月后脑电图改善情况、血清指标及认知功能变化情况。结果治疗3个月后,联合组患儿脑电图改善率为86.79%,明显高于单药组改善率69.39%(P0.05)。治疗前2组患儿血清NSE、Hcy、NPY水平及各认知功能评分差异无统计学意义(P0.05);治疗3个月后联合组患儿血清NSE、Hcy水平明显低于单药组(P0.05),联合组血清NPY水平及视空间、注意、语言、定向、MoCA总分均显著高于单药组(P0.05)。联合组不良反应总发生率为16.98%,单药组为12.24%,差异无统计学意义(P0.05)。结论丙戊酸钠联合托吡酯治疗小儿部分发作性癫痫的效果良好,能有效降低患儿血清NSE、Hcy水平,提高血清NPY水平,改善患儿认知功能。     

托吡酯抗癫痫治疗对糖代谢的影响

目的观察癫痫患者服用托吡酯后血糖、胰岛素、胰岛素抵抗指数等变化,评估托吡酯对于抗癫痫治疗的临床意义及局限性。方法回顾性分析2014-06—2016-05我院神经内科门诊及住院的78例癫痫患者临床资料,随机分成2组,托吡酯组40例给予托吡酯治疗,丙戊酸钠组38例给予常规的丙戊酸钠治疗,分别于治疗前和治疗后3个月、6个月检测2组糖代谢指标差异及不良反应发生情况。结果 2组治疗后体质量、胰岛素、IR、瘦素及脂联素比较差异有统计学意义(P0.05)。托吡酯不良反应发生率为12.5%,显著低于丙戊酸钠组的23.7%,差异有统计学意义(P0.05)。结论 (1)癫痫患者葡萄糖代谢存在异常,抗癫痫药物对癫痫患者糖代谢存在影响;(2)托吡酯与丙戌酸钠均会导致癫痫患者糖代谢指标出现不同程度的下降或升高,故两种药物是否可作为理想药物尚待进一步研究,建议临床合理选用抗癫痫药物,尽可能减少药物不良反应。     

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

目的探讨卡马西平、托吡酯与丙戊酸钠治疗脑炎继发癫痫的临床疗效。方法将126例脑炎继发癫痫患者随机分为观察A组(n=42)、观察B组(n=42)及观察C组(n=42),分别给予卡马西平、托吡酯及丙戊酸钠治疗,对比3组患者临床效果。结果观察A、B、C 3组治疗总有效率比较差异无统计学意义(73.8%,76.2%,78.6%)(P0.05);观察B组不良反应发生率为14.3%,显著低于观察A组的45.2%和观察C组的30.9%(P0.05);观察组A组对PS型发作的疗效显著优于观察组B、C组(P0.05)。结论卡马西平、托吡酯、丙戊酸钠对于脑炎继发癫痫患者均具有确切疗效,但托吡酯不良反应发生率相对较低,可作为治疗首选临床用药。     

不同药物与脑电图放电指数对癫痫儿童认知功能的影响

目的探讨丙戊酸钠、托吡酯、脑电图放电指数对学龄期癫痫患儿认知功能的影响。方法 62例癫痫患儿按照随机数字表法分为2组。A组口服丙戊酸钠治疗,B组口服托吡酯治疗。另选择同期在我院健康体检的正常儿童36例为对照组。观察治疗前后A组和B组患儿认知功能情况。结果 A组、B组言语智商、操作智商、总智商评分明显低于对照组(P0.01)。A组治疗前后言语智商、操作智商、总智商评分比较无明显差异(P0.05)。B组治疗前后操作智商评分比较无统计学差异(P0.05),言语智商、总智商评分明显低于治疗前(P0.01)。放电指数≥0.5组患儿言语智商、操作智商、总智商评分明显低于放电指数0.5组患儿(P0.01)。结论托吡酯治疗学龄期儿童癫痫时对患儿认知功能可造成损害,而丙戊酸钠无明显影响,安全性较高。脑电图放电指数与癫痫患儿认知功能关系密切,临床在治疗癫痫时宜定期复查脑电图。     

拉莫三嗪联合丙戊酸钠治疗对癫痫患儿疗效改善不良事件及预后的影响研究

目的探讨拉莫三嗪联合丙戊酸钠治疗对癫痫患儿疗效改善、不良事件及预后的影响。方法选取我院2014-11-2015-11收治癫痫患儿124例予以回顾性分析,按临床不同治疗方案分成2组,行单纯丙戊酸钠治疗的56例患儿为对照组,行拉莫三嗪和丙戊酸钠联合治疗的68例患儿为观察组,对2组疗效改善、不良事件及预后情况进行对比。结果观察组治疗3、6个月后癫痫发作次数均减少,其减少幅度均比对照组显著(P0.01);观察组总不良事件发生率8.82%低于对照组37.50%(P0.01);观察组治疗3、6个月后TG、TC改善效果优于对照组(P0.01)。结论癫痫患儿行拉莫三嗪和丙戊酸钠联合治疗能够减少癫痫发作次数和不良事件发生,且促进预后改善,具有推广及应用价值。     

托吡酯联合丙戊酸钠治疗小儿癫痫临床观察

目的分析托吡酯联合丙戊酸钠治疗小儿癫痫的临床效果及对血清细胞因子水平的影响。方法选取2014-03—2016-11在解放军第152中心医院接受治疗的癫痫患儿180例,随机分为观察组(n=90)与对照组(n=90)。2组均给予托吡酯治疗,观察组同时联合丙戊酸钠治疗。结果观察组有效率92.22%,对照组为82.22%。观察组有效率明显高于对照组(P0.05)。2组治疗后NSE、Hcy、IGF-1水平均有显著改善,观察组改善更加明显,差异有统计学意义(P0.05)。2组治疗后IL-2、IL-6、TNF?α水平均有显著改善,观察组改善更加明显,差异有统计学意义(P0.05)。结论托吡酯联合丙戊酸钠治疗小儿癫痫的临床效果显著,安全性高,且有利于改善血清细胞因子水平。     

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。     

抗癫痫药治疗躁狂发作的对照研究

目的 比较托吡酯和丙戊酸钠缓释片治疗双相障碍躁狂发作的疗效和安全性.方法 将符合CCMD-3双相情感障碍躁狂发作标准的90例患者,随机分为托吡酯与奎硫平组、丙戊酸钠缓释片与奎硫平两组,进行为期8周的治疗,用BRMS躁狂量表评定疗效,药物副反应量表评定副反应.结果 托吡酯组有效率为84.4%,丙戊酸纳缓释片组有效率为88.8%,两组间差异无统计学意义（χ2=0.39,P＞0.05）.治疗2周时托吡酯组与丙戊酸纳缓释片组减分率比较上差异有统计学意义.结论 托吡酯治疗双相情感障碍躁狂发作的疗效与丙戊酸钠缓释片相当,不良反应可耐受,可长期使用.     

托吡酯和丙戊酸钠预防偏头痛发作的对比研究

目的对比研究托吡酯和丙戊酸钠预防偏头痛发作的疗效及安全性。方法采用前瞻性的方法，随机将偏头痛患者分为两组：（1）托吡酯组（74例），采用托吡酯，第1周每日25mg开始，每周日递增25nlg，最高剂量增至每日100mg，分早晚两次口服；（2）丙戊酸钠组（72例），采用丙戊酸钠每日400mg，分早晚两次口服，最高剂量增至每日600mg。丽组服药持续3个月。观察两组患者治疗前后的头痛发作频率、头痛发作天数和疼痛程度，并进行对比。头痛程度采用0～10分评分法，观察时间为13周，此期间患者记录头痛日记。结果发作频率：托吡酯组从每月7．01次减少至1．89次（P〈0．001），丙戊酸钠组从每月6．87次减少至1．91次（P〈0．001），两组之间差异无统计学意义（P〉0．05）；头痛发作天数：托吡酯组从7．28d减少至1．89d（P〈0．001），丙戊酸钠组从7．09d减少至2．40d（P〈0．001），两组差异无统计学意义（P〉0．05）；头痛程度：托吡酯组从8．05分减轻至2．02分（P〈0．001），丙戊酸钠组从7．56分减轻至3．62分（P〈0．001），两组之间差异有统计学意义（P〈0．05）。托吡酯最常见的不良反应为肢体麻木、头晕、乏力和食欲减退，丙戊酸钠的不良反应为恶心、呕吐、血白细胞降低、转氨酶升高。结论托吡酯和丙戊酸钠均能有效预防偏头痛发作，但在减轻头痛程度方面，托吡酯比丙戊酸钠效果更好。     

小剂量托吡酯联合奥卡西平治疗小儿癫痫的疗效观察

目的研究小剂量托吡酯联合奥卡西平治疗小儿癫痫的临床效果。方法选取60例小儿癫痫患儿为研究对象,随机分为2组各30例,所有患儿给予奥卡西平治疗,在此基础上,对照组加用常规剂量托吡酯治疗,观察组加用小剂量托吡酯治疗,治疗6个月后,比较2组临床疗效、住院时间、不良反应发生率、癫痫发作次数。结果观察组总有效率96%,对照组为90%,2组比较差异无统计学意义(P0.05)。观察组住院时间显著少于对照组,不良反应发生率显著低于对照组,差异均有统计学意义(P0.05);治疗6个月后,2组癫痫发作次数均较治疗前明显减少(P0.05),组间比较差异无统计学意义(P0.05)。结论采用小剂量托吡酯联合奥卡西平治疗小儿癫痫临床疗效显著,可有效减少药物不良反应,缩短患儿住院治疗时间,是一种高效安全的治疗方案。     

丙戊酸钠联合左乙拉西坦治疗小儿癫痫的疗效

目的探讨丙戊酸钠联合左乙拉西坦治疗小儿癫痫的临床疗效。方法将92例小儿癫痫患者随机分为对照组和实验组,在丙戊酸钠治疗基础上,对照组联合托吡酯治疗;实验组联合左乙拉西坦治疗。结果实验组总有效率93.5%高于对照组78.3%,治疗前,2组患者血钙和血磷水平无显著差异(P0.05);但治疗后实验组血钙水平(2.39±0.36)mmol/L、血磷水平(1.45±0.36)mmol/L均低于对照组(2.07±0.18)mmol/L、(1.21±0.15)mmol/L(均P0.05)。结论丙戊酸钠、左乙拉西坦联合用药治疗小儿癫痫疗效显著,且对钙、磷代谢影响较小,安全性高,临床值得应用。     

Severe myoclonic epilepsy in infancy: toward an optimal treatment

Severe myoclonic epilepsy in infancy, or Dravet syndrome, is one of the catastrophic epilepsy syndromes. In the past, treatment was mainly based on valproate and phenobarbital. Recently, some of the new antiepilepsy drugs, such as topiramate and stiripentol, have been shown to be promising in the treatment of this epilepsy syndrome. The treatment regimen of 12 children with Dravet syndrome and proven mutations in the alpha subunit of the sodium channel SCN1A is reported here. Five patients on the "traditional" treatment regimen are compared with seven children on an "optimal" treatment regimen based on a combination of valproate and topiramate. With respect to the literature and our own experience, we propose guidelines for "optimal" treatment of children with severe myoclonic epilepsy in infancy. This includes prevention of hyperthermia, rigorous treatment of fever, avoiding stressful situations, maintenance treatment based on a combination of only two antiepilepsy drugs (ie, valproate and topiramate), and a strict acute seizure treatment based on benzodiazepines. To prevent long-lasting periods of status epilepticus, this acute seizure treatment must be taught to parents and caregivers.     

依达拉奉联合丙戊酸钠对脑卒中后继发癫痫患者的临床疗效、神经元特异性烯醇化酶、炎症因子及不良反应的研究

目的探讨依达拉奉联合丙戊酸钠对脑卒中后继发癫痫(PSE)患者的神经元特异性烯醇化酶(NSE)、炎症因子及不良反应的影响及临床疗效。方法选取我院2015年10月至2016年10月收治的100例PSE患者,随机数字表法分为两组:在常规治疗基础上,对照组50例予丙戊酸钠;观察组50例予丙戊酸钠联合依达拉奉。治疗1年后,比较两组疗效、癫痫发作情况、NSE、炎症因子水平及安全性。结果1年后观察组总有效率92. 0%高于对照组的74. 0%(P 0. 05)。癫痫发作次数和持续时间少于对照组(P 0. 05)。1月末观察组NSE水平低于对照组(P 0. 05);在后续治疗中两组NSE水平无明显差异(P 0. 05)。观察组的肿瘤坏死因子-α(TNF-α)、白细胞介素-2 (IL-2)和IL-8水平低于对照组(P 0. 05)。两组不良反应发生率分别为24. 0%和28. 0%,差异无统计学意义(P 0. 05)。结论依达拉奉联合丙戊酸钠对PSE患者疗效显著,可显著降低NSE和炎症因子水平,且安全性较好。     

An observational study of first-line valproate monotherapy in focal epilepsy

The objective of this multinational open-label, prospective study was to collect, under naturalistic conditions, data on the effectiveness and tolerability of first-line monotherapy with valproate in subjects newly or recently diagnosed with focal onset epilepsy. Patients were treated with sustained release sodium valproate. Seizure control and occurrence of adverse events were assessed after 6 months. Around 1192 adults and 792 children were included. The mean daily valproate dose was 683 mg in children and 987 mg in adults. The retention rate at 6 months was 90.0%. At this time, 77% of subjects were seizure free (83.7% of children and 72.7% of adults). Adverse events possibly related to treatment were observed in 10.2% of subjects, leading to treatment modification for 1.7%. The most common adverse events were weight gain, gastro-intestinal, neurological and skin disorders. Sustained release sodium valproate is effective and shows acceptable tolerability as first-line monotherapy in focal onset epilepsy.     

长期应用托吡酯、丙戊酸钠对于血脂水平的影响

目的 观察长期应用托吡酯、丙戊酸钠单药治疗对癫痫患者血脂水平的影响。 方法 连续入组长期单药应用丙戊酸钠控制良好的癫痫患者28例、单药应用托吡酯控制良好的癫痫患者30例,并选取健康对照60例,观察各组间血脂代谢指标的差异。 结果 丙戊酸钠组血清脂蛋白（a）水平显著高于托吡酯组（P<0.001）及健康对照组（P=0.003）,而总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯水平较其他两组无明显差异。托吡酯组的总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、脂蛋白（a）、甘油三酯水平较对照组均未有显著差异。 结论 长期单药应用丙戊酸钠有可能增加癫痫患者脂蛋白（a）的水平,而长期单药应用托吡酯对于血脂水平影响并不明显。     

Efficacy and safety of topiramate in refractory epilepsy of childhood: long-term follow-up study

This study aimed to evaluate the long-term efficacy and safety of topiramate in treating children with drug-resistant epilepsy. A multicentric, retrospective, open-label, add-on study was undertaken of 277 children (mean age 8.4 years; range 12 months to 16 years) affected by drug-resistant epilepsy. The efficacy was rated according to the seizure types and epilepsy syndrome. After a mean period of 27.5 months of treatment (range 24-61 months), 11 patients (4%) were seizure free and 56 (20%) had more than 50% reduction in seizure frequency. The efficacy of topiramate treatment was noted in localization-related epilepsy and in generalized epilepsy. In addition, in a group of 114 patients, we compared the initial efficacy (evaluated after a mean of 9 months of follow-up) and the retention at a mean of 30 months of topiramate with regard to loss of efficacy (defined as the return to the baseline seizure frequency). Fifty-five (48%) of 114 patients were initial responders. The retention at a mean of 30 months was 23 of 114 patients (20%), 4 of whom (3.5%) were still seizure free. A loss of efficacy occurred in 32 of the 55 initial responders (58%). It was prominent in patients with generalized epilepsy, such as symptomatic infantile spasms and Lennox-Gastaut syndrome, as well as in those with Dravet syndrome. By contrast, a well-sustained topiramate efficacy was noted among patients with localization-related epilepsy. Globally, adverse events were observed in 161 patients (58%) and were mainly represented by weight loss, hyperthermia, sedation, and nervousness, which, in most cases, disappeared after slowing titration or reducing the dosage of the drug. In conclusion, the present long-term study confirms that topiramate represents a useful drug effective in a wide range of seizures and epilepsy syndromes. Moreover, preliminary data seem to suggest that the efficacy of topiramate, when evaluated in the long-term perspective, is more sustained in localization-related epilepsy than in generalized epilepsy.     

左乙拉西坦治疗60例小儿癫痫的疗效和安全性分析

目的探讨左乙拉西坦在小儿癫痫治疗中的疗效和安全性。方法从我院2013-06—2014-06小儿神经内科专科门诊部收治的癫痫患儿中随机性抽取60例作为研究对象,采用开放性自对照随访研究方法。60例患儿均给予左乙拉西坦口服治疗,随访6~10个月,观察治疗前后癫痫发作频率变化、脑电图改变情况以及患儿治疗期间的不良反应,评价左乙拉西坦治疗小儿癫痫的疗效和安全性。结果本组患儿均成功获得随访,治疗后完全控制26例,有效20例,无效12例,加重2例,总有效率76.67%,且不同类型癫痫患儿治疗后的发作次数明显低于治疗前(P0.01)。脑电图检查痫样放电消失31例,痫样放电减少50%以上10例,痫样放电减少25%~49%9例,痫样放电无变化7例,痫样放电增加3例。本组治疗期间18例发生不良反应,不良反应发生率30.00%,主要表现为情绪异常、嗜睡乏力、皮疹等症状,给予对症治疗后均得到缓解,无严重影响治疗的不良反应。结论左乙拉西坦治疗儿童癫痫的疗效确切,不良反应少,是一种安全有效的药物。     

A multicentre comparative trial of sodium valproate and carbamazepine in adult onset epilepsy. Adult EPITEG Collaborative Group.

The long-term efficacy and safety of sodium valproate and carbamazepine in adult outpatients with newly diagnosed primary generalised or partial and secondarily generalised seizures were compared in a randomised, open, multicentre study at 22 neurology outpatient clinics. Patients were randomised to oral sodium valproate (Epilim EC enteric coated 200 mg tablets twice daily, n = 149) or oral carbamazepine (100 mg twice daily increasing to 200 mg twice daily in week 2, n = 151) and followed up for three years. If clinically necessary, dosages were regularly increased until seizures were controlled or toxicity developed. Sodium valproate and carbamazepine controlled both primary generalised and partial seizures equally effectively overall. Significantly more patients on sodium valproate than carbamazepine (126/140 (90%) v 105/141 (75%), p = 0.001) remained on randomised treatment for at least six months. Skin rashes occurred significantly more often in carbamazepine recipients than in sodium valproate recipients (11.2% v 1.7%, p < 0.05) and carbamazepine was associated with a higher withdrawal rate because of adverse events (15% v 5% on sodium valproate) in the first six months of treatment. There was no difference between the drugs in the rate of withdrawal because of poor seizure control at any stage, regardless of seizure type. At the end of the three year trial period, over 70% of the available patients were still on randomised treatment or had recently stopped treatment after achieving full seizure control. Sodium valproate and carbamazepine were both associated with a high degree of overall seizure control regardless of seizure type and both have good long-term tolerability in adult patients with newly diagnosed epilepsy. Recommendations are made for a higher initial dosage regime for sodium valproate in partial seizures.     

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.