Auditory event related potentials in patients with epilepsy on sodium valproate monotherapy

Objectives - The effects of antiepileptic drugs on event related potentials (ERPs) have been studied, but with contradictory results. In this study we examine the effect of sodium valproate (VPA) on ERPs in patients with epilepsy. Material and methods - Auditory event related potentials were recorded in 40 patients with idiopathic generalized epilepsy, 20 on monotherapy with sodium valproate (VPA), 20 on monotherapy with carbamazepine and 20 age and sex matched controls. All subjects performed a simple auditory discrimination task in which a target tone was presented on 20% of the trials. Results - Mean P3 latency of the VPA group was significantly prolonged but not in carbamazepine group and healthy controls. Conclusion - We conclude that VPA monotherapy has an effect on P300 latency in patients with epilepsy. This difference might be attributed to effects of troatmeni with VPA and mav clarifv in the future the mechanism of P300.     

Low dose sodium valproate in the treatment of juvenile myoclonic epilepsy

Fourteen patients with juvenile myoclonic epilepsy (JME) were treated with a single low dose of a sustained-release preparation of sodium valproate (VPA, 500 mg daily). The mean age of the onset of the low dose treatment was 19.2 years (range 14–26). Before this treatment, six patients had been treated with high dose VPA for a period of more than 2 years, three patients for 1 to 2 years, three patients less than 1 year and two patients initiated the treatment from the begining with a low dose. The mean duration of low dose treatment is 35.6 months (range 25–59 months). (All patients are still under medication). Generalized tonic-clonic and absence seizures were controlled in all patients. Myoclonic jerks relapsed only in one patient, a young mother who was looking after her newly born baby and was deprived of sleep. No adverse reactions have been reported. We suggest that JME patients can effectively be treated with single low VPA dose (500 mg daily), while at the same time seizure precipitating factors, such as sleep deprivation and alcohol ingestion, should be avoided. Received: 26 January 2001, Received in revised form: 30 July 2001, Accepted: 3 August 2001     

A controlled study with taltrimide and sodium valproate: valproate effective in partial epilepsy

Taltrimide was compared with valproate and placebo in 17 patients with intractable epilepsy being on carbamazepine monotherapy. Taltrimide (400 mg/day), valproate (1000 mg/day) or placebo were added to the treatment for periods of 3 months using a randomized cross-over design. Serum carbamazepine concentrations remained within the therapeutic range throughout the trial. Thirteen patients completed the study. In partial epilepsy of 7 the seizure frequency was reduced by 27% during valproate (p less than 0.05), compared with placebo, while no improvement was found during taltrimide. In 6 with primary generalized epilepsy, the number of seizures was reduced by 49% during taltrimide and by 38% during valproate, but neither effect was significant, compared with placebo. Headache was reported by 3 patients while on taltrimide. One with hypersensitivity history developed petecchiae and nasal bleeding during taltrimide and, therefore, the treatment was stopped. The three other interruptions were independent of taltrimide. Thus, the only statistically significant effect in this study was that of valproate in partial epilepsy.     

拉莫三嗪联合丙戊酸钠治疗脑卒中继发癫痫患者的疗效观察

目的 观察拉莫三嗪联合丙戊酸钠治疗脑卒中继发癫痫患者的临床疗效.方法 选取我院2011-01-2012-01收治的80例脑卒中继发癫痫患者为研究对象,将患者抽签速记分为观察组与对照组,每组40例.对照组给予丙戊酸钠治疗,观察组给予拉莫三嗪联合丙戊酸钠治疗,比较2组临床疗效,比较治疗前、治疗6个月、12个月后癫痫发作持续时间、生活质量评分及不良反应发生率.结果 观察组有效率95.00％,高于对照组的80.00％,差异有统计学意义(P＜0.05).2组治疗前癫痫发作持续时间、生活质量评分比较差异无统计学意义(P＞0.05);治疗6个月、12个月后癫痫发作持续时间(2.76±1.53)min/次、(2.25±1.23)min/次,低于对照组;生活质量评分(63.82±6.30)分、(78.95±6.71)分,高于对照组,差异均有统计学意义(P＜0.05).2组不良反应发生率比较差异无统计学意义(P＞0.05).结论 拉莫三嗪联合丙戊酸钠治疗脑卒中后继发性癫痫,可提高临床疗效,缩短癫痫发作持续时间,提高生活质量,且不增加不良反应发生率,具有较好的临床应用价值.     

托吡酯联合丙戊酸钠治疗儿童癫痫的有效性及安全性

目的探讨托吡酯联合丙戊酸钠治疗儿童癫痫的有效性及安全性。方法选取80例癫痫患儿,随机分为对照组和联合组各40例,对照组给予托吡酯单药治疗,联合组在对照组用药基础上加用丙戊酸钠治疗。观察2组疗效及不良反应发生情况。结果治疗3个月时联合组治疗总有效率95.00%高于对照组80.00%(P0.05),治疗6个月时2组治疗总有效率分别为97.50%、87.50%,差异无统计学意义(P0.05);治疗3、6个月时2组癫痫发作月均频率明显低于治疗前(P0.01),治疗6个月癫痫发作月均频率明显低于治疗3个月(P0.01),治疗3、6个月时联合组癫痫发作月均频率明显低于对照组(P0.01);对照组不良反应发生率10.00%,联合组为15.00%,差异无统计学意义(P0.05)。结论托吡酯联合丙戊酸钠治疗儿童癫痫可在短期内减少癫痫发作频率,未明显增加不良反应发生率,耐受性较好。     

Hormone profiles in young adults with epilepsy treated with sodium valproate or lamotrigine monotherapy

PURPOSE: Treatment with sodium valproate (VPA) may be associated with polycystic ovarian syndrome (PCOS) in some women with epilepsy. By comparing hormone profiles in young adults taking VPA or lamotrigine (LTG) as monotherapy, this study aimed to explore whether a pharmacologic effect of VPA could be responsible for this observation. METHODS: Hormone profiles in men and women taking VPA (n = 40) or LTG (n = 36) monotherapy for epilepsy were compared. None of the women were receiving hormonal contraception or replacement. Patients gave details of seizure type and frequency, menstrual cycle, and medical and drug history. Body mass index was calculated, and fasting insulin, glucose, cholesterol, triglycerides (TG), high- and low-density lipoproteins, testosterone, dihydroepiandosterone (DHEA), androstenedione, sex hormone-binding globulin (SHBG), free androgen index (FAI), luteinising hormone (LH), follicle-stimulating hormone (FSH), and antiepileptic drug (AED) concentrations were measured. RESULTS: There were no differences between treatment groups for both sexes in age and seizure control. Only four obese VPA-treated women were hyperinsulinaemic (p = 0.05); three with abnormal menstrual cycles; one with raised testosterone. Testosterone (p = 0.02), FAI (p = 0.03), and TG (p = 0.02) levels were higher, however, in women taking the drug. Obese patients of both sexes (p = 0.01) and VPA-treated men (p = 0.03) had higher insulin concentrations. CONCLUSIONS: VPA therapy may be associated with subclinical elevation in fasting insulin levels. Testosterone and TG levels were higher in VPA-treated women compared with the levels in those taking LTG. However, only a minority of obese females exhibited biochemical characteristics suggestive of PCOS. Biochemical screening may allow women at risk of developing PCOS to avoid VPA.     

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。     

丙戊酸钠对癫痫患儿血糖及血清胰岛素的影响

目的通过检测服用丙戊酸钠癫患儿血糖及血清胰岛素水平,观察丙戊酸钠对癫患儿血糖及血清胰岛素的影响。方法采用葡萄糖氧化酶法测定葡萄糖浓度,采用放射免疫分析法测定胰岛素浓度。结果丙戊酸钠治疗3个月、6个月时癫患儿的血清胰岛素、胰岛素抵抗指数较治疗前均明显增高(P<0.05),治疗3个月时和6个月时相比差异无统计学意义(P>0.05),但血糖无明显变化(P>0.05)。结论丙戊酸钠不引起癫患儿血糖明显变化,但血清胰岛素明显增加。     

3D movies and risk of seizures in patients with photosensitive epilepsy

3D television (TV) and cinema have experienced a recent surge in popularity aided in part by the success of films such as “Toy Story 3” and “Avatar”. In parallel with this trend there have been increasing concerns about the safety of 3D TV and cinema for patients with photosensitive epilepsy. General practitioners, paediatricians and neurologists are being consulted about their opinions on the risk of triggering a seizure.Photosensitive epilepsy occurs in 1 in 4000 of the population but the incidence is higher in people aged 7-19 years. We found little evidence in the literature and confusing advice on various websites. We discuss this evidence in an attempt to clarify the advice that health professionals should be giving on this issue.We conclude that 3D cinema and television are only unlikely to trigger seizures in patients with non-photosensitive epilepsy. In young people with photosensitive epilepsy the risk of triggering a seizure is not greater with 3D TV or cinema than with conventional television, and we suggest means by which this risk can be minimised. We suggest removing 3D glasses when watching conventional TV to prevent the eyes from picking up flicker. Unfortunately there is currently insufficient evidence to draw more formal conclusions and clinical trials would be of great benefit.     

丙戊酸钠改善精神分裂症患者认知功能障碍的对照研究

目的 探讨丙戊酸钠改善精神分裂症患者认知功能障碍的疗效.方法 将80例精神分裂症患者随机分成研究组(40例)和对照组(40例),研究组患者使用新型抗精神病药合并丙戊酸钠系统治疗,对照组患者单用新型抗精神病药物系统治疗,共治疗8周.全部病例在治疗前后分别进行阳性和阴性综合征量表(PANSS)、韦氏成人智力量表(WAIS-RC)、韦氏记忆量表(WMS)、威斯康星卡片分类测验(WCST)进行疗效评定,应用治疗中需处理的不良反应症状量表(TESS)评定不良反应.结果 与基线时比较,两组在治疗后第4、8周末PANSS总分及各因子分均有明显降低(P＜0.05),研究组治疗后第8周末PANSS总分及各因子分均显著低于对照组(P＜0.05).治疗后第8周末,两组WMS、WAIS-RC、WCST评分与基线时比较,除即刻记忆评分外其余各项评分差异均有统计学意义(P＜0.05),两组间比较,除即刻记忆评分外其余各项评分均有显著性差异(P ＜0.05,P＜0.01).结论 丙戊酸钠对精神分裂症患者的认知功能障碍有明显改善效果.     

Suppressive efficacy by a commercially available blue lens on PPR in 610 photosensitive epilepsy patients

PURPOSE: Photosensitivity can represent a serious problem in epilepsy patients, also because pharmacologic treatment is often ineffective. Nonpharmacologic treatment using blue sunglasses is effective and safe in controlling photosensitivity, but large series of patients have never been studied. METHODS: This multicenter study was conducted in 12 epilepsy centers in northern, central, southern, and insular Italy. A commercially available lens, named Z1, obtained in a previous trial, was used to test consecutively enrolled pediatric and adult epilepsy patients with photosensitivity. Only type 4 photosensitivity (photoparoxysmal response, PPR) was considered in the study. A standardized method was used for photostimulation. RESULTS: Six hundred ten epilepsy patients were tested. Four hundred (66%) were female patients; 396 (65%) were younger than 14 years. Three hundred eighty-one (62%) subjects were pharmacologically treated at the time of investigation. Z1 lenses made PPR disappear in 463 (75.9%) patients, and PPR was considerably reduced in an additional 109 (17.9%) of them. PPR remained unchanged only in the remaining 38 (6.2%) patients. The response of PPR to Z1 lenses was not significantly influenced by the patients' age, sex, or type of epilepsy. No difference was found between pharmacologically treated and untreated patients. CONCLUSIONS: The Z1 lens is highly effective in controlling PPR in a very large number of photosensitive epilepsy patients irrespective of their epilepsy or antiepileptic drug treatment. The lens might become a valid resource in the daily activity of any clinician who cares for patients with epilepsy.     

Role of valproate across the ages. Treatment of epilepsy in adults

A workshop was held in Göteborg in June 2005 to discuss the place of valproate in treating adult epilepsies. Consensus positions were developed on the epilepsy types for which the drug is most suitable and the use of valproate in women of child-bearing age, in men and in patients with psychiatric comorbidity. Valproate was considered to be effective across a broad variety of epilepsy syndromes and seizure types and should be considered a suitable choice for first-line monotherapy of juvenile myoclonic epilepsy and other idiopathic generalized epilepsies. The use of valproate by women of child-bearing age is associated with potential harm to the foetus. A conservative approach to treatment is recommended in these patients whereby alternative antiepileptic drugs should be proposed to women planning pregnancies wherever satisfactory seizure control can be thereby maintained. In cases where valproate is used during pregnancy, either because the pregnancy was unplanned or because alternative treatment options of equivalent efficacy are unavailable, appropriate counselling, precautionary measures and monitoring should be provided. The evidence for an impact of valproate on male reproductive health is equivocal and considerations of male fertility should not be taken into account in deciding whether to prescribe valproate to men. Valproate can be proposed safely to patients with comorbid psychiatric disease or underlying psychiatric vulnerability.     

Monozygous twin brothers discordant for photosensitive epilepsy: first report of possible visual priming in humans

PURPOSE: The interaction of genetic predisposition and the environment in the development of epilepsy is often discussed, but, aside from some animal reflex epilepsies, little evidence supports such interaction in the development of reflex epilepsy in humans. METHODS: We describe the history of a 16-year-old boy in whom photosensitive epilepsy developed after a period of weekly exposures to high-intensity light flashes. RESULTS: Both he and his clinically unaffected monozygotic twin were found to be photosensitive. CONCLUSIONS: This case report suggests that some genetic forms of human reflex epilepsy may be elicited by repeated environmental exposure to the appropriate stimulus, similar to some of the stimulus-induced epilepsies seen in animals.     

Role of valproate across the ages. Treatment of epilepsy in the elderly

In June 2005, a team of experts participated in a workshop with the objective of reaching agreement on several important aspects of valproate in the treatment of elderly patients with epilepsy. Epilepsy in the elderly is relatively common and its incidence increases for each decade after age 60. The aetiology and manifestations of epilepsies in the elderly are complex because of comorbidity and other underlying risk factors. A consensus was reached that elderly patients who present with a seizure disorder should be referred rapidly to a specialist and that diagnosis should be improved by using a multidisciplinary team of cardiologists, neurologists and epilepsy experts (syncope, falls and seizure specialists). This is especially important to avoid mistreatment with antiepileptic drugs (AEDs). There was consensus that the elderly are generally more susceptible to the adverse effects of AEDs than younger adults. For these reasons, in older persons AEDs should be started at low dosages, and titrated slowly according to clinical response. Some of the most troublesome side effects of AEDs in the elderly include sedation and cognitive side effects, as well as osteoporosis. Drug–drug interactions should be given special consideration. There was consensus that the pharmacokinetics of all AEDs are altered in the elderly, and that the most significant change common to all AEDs is a moderate reduction in renal and metabolic clearance. Predicting pharmacokinetic changes in the individual, however, can be very difficult because multiple factors contribute to a high inter-patient variability. There was agreement on the advantages and disadvantages of the use of valproate in the elderly, and consensus that valproate is a useful option in this population. There was no consensus, however, on whether valproate should be considered among the preferred first-line treatments in the elderly.     

丙戊酸钠与地西泮治疗酒清戒断反应的临床对照研究

目的探讨丙戊酸钠对酒精戒断反应的临床疗效及副反应.方法对61例慢性酒精中毒患者应用丙戊酸钠(31例)与地西泮(30例)进行对照治疗,疗程1周,采用戒断症状量表、汉密尔顿焦虑量表(HAMA)和有关实验室等检查评定疗效和副反应.结果丙戊酸钠与地西泮疗效相近(P＞0.05).治疗前后戒断症状量表、HAMA量表总分减分率两组均有显著性差异.HAMA的精神性焦虑因子减分率丙戊酸钠组大于地西泮组(P＜0.05).两组副反应均很少且轻微.结论丙戊酸钠与地西泮对酒精戒断反应均有良好疗效,但丙戊酸钠一般不会造成滥用和成瘾.     

碳酸锂合并丙戊酸钠预防双相障碍复发的研究

目的比较碳酸锂合并丙戊酸钠与单用碳酸锂对预防双相障碍复发的疗效。方法对82例临床康复的双相障碍患者随机分为碳酸锂合并丙戊酸钠组及单用碳酸锂组,合并用药组44例,单用碳酸锂组38例,随访观察2年。结果合并用药组有效率为88.6%,单用碳酸锂组有效率为68.4%,两组比较差异有显著性(P<0.05)。结论碳酸锂合并丙戊酸钠对双相障碍有较好的预防复发作用。     

Role of valproate across the ages. Treatment of epilepsy in children

In June 2005 a team of experts participated in a workshop with the objective of reaching agreement on the place of valproate use in the treatment of paediatric epilepsy patients. A general 'consensus of the meeting' was that the initiation of antiepileptic drug (AED) treatment should be based on a seizure-syndromic approach in children. Participants of the meeting also agreed that valproate is currently the AED with the broadest spectrum across all types of seizures and syndromes. Its superiority has been shown over almost 40 years of clinical experience. The best results are seen in idiopathic generalized epilepsy with or without photosensitivity, idiopathic focal and symptomatic generalized tonic–clonic seizures (GTCS). Evidence supports the use of valproate, ethosuximide and lamotrigine in absence epilepsies and the use of carbamazepine, lamotrigine, oxcarbazepine, phenytoin, topiramate, valproate and phenobarbital for primary GTCS. For new AEDs trials have been undertaken to define their therapeutic role but studies comparing their role to 'old' broad-spectrum drugs in specific syndromes are missing. Experts concluded that intravenous (i.v.) valproate is a useful agent in the treatment of non-convulsive status epilepticus (SE). There is an easy transition to oral treatment following i.v. valproate use. The discussion also concluded that, despite the lack of studies, valproate is an interesting, underutilized alternative in convulsive SE but more controlled studies are needed. The side effects of valproate use are well documented. Its effect on cognition and behaviour is more favourable than many of the other AEDs which is an important consideration in children. Overall, the clinical consensus of the meeting was that valproate's well established therapeutic properties far outweigh the negative side effects. Contraindication or withdrawal should be assessed individually.     

丙戊酸钠治疗迟发性运动障碍的双盲对照研究

目的：探讨丙戊酸钠治疗抗精神病药所致迟发性运动障碍(TD)的疗效及安全性。方法：对80例长期服用抗精神病药治疗且符合TD诊断标准的男性精神分裂症患者，随机分为治疗组和对照组，分别给予丙戊酸钠和安慰剂治疗。采用异常不自主运动量表(AIMS)和简明精神病评定量表(BPRS)及副反应量表(TESS)在治疗前及治疗后1、2、4、6周末分别评定疗效及不良反应。结果：治疗组于治疗后4周AIMS评分有显著下降，治疗后6周较对照组显著为低。有效率64．1％，显著较对照组的25．0％为高。结论：丙戊酸钠治疗抗精神病药所致TD有效，但以低剂量为宜，应注意监测血象。     

丙戊酸钠与卡马西平治疗躁狂发作临床观察

目的：评价丙戊酸钠与卡马西平对锂盐治疗无效的躁狂发作的疗效和副反应。方法：将符合CCMD－2－R躁狂发作诊断标准的5例患者随机分为丙戊酸钠组和卡马西平组,治疗6周。使用Bech-Rafaelsen躁狂量表及临床疗效总评量表的疗效总评评定疗效,用副反应量表及有关实验室检查评定副反应。结果：丙戊酸钠与卡马西平均能有效减轻躁狂症状,疗效相近,丙戊酸钠起效时间迟于卡马西平。丙戊酸钠的副反应主要为肠道反应、震颤等、而卡马西平以共济失调、头晕、嗜睡等多见。结论：丙戊酸钠与卡马西平均可用于锂盐治疗无效的躁狂发作。