丙戊酸钠对氯氮平血药浓度和疗效的影响

目的:探讨合用丙戊酸钠对氯氮平治疗精神分裂症时的血药浓度和疗效的影响。方法:将80例男性精神分裂症患者随机分为两组,单用组40例患者单服氯氮平,合用组40例患者同时服用氯氮平及丙戊酸钠,分别于治疗前、治疗1周和4周末测定氯氮平的血药浓度,同时评定阳性与阴性症状量表(PANSS)、治疗中出现的症状量表(TESS)。结果:合用组治疗1周和4周末有部分患者氯氮平血药浓度升高,部分患者降低,与基线期相比,治疗4周末有显著降低。结论:合用丙戊酸钠后氯氮平血药浓度治疗4周末显著降低;丙戊酸钠可以提高氯氮平对阳性症状的疗效。     

Antiepileptic effect and serum levels of clorazepate on children with refractory seizures

Clorazepate dipotassium is rapidly decarboxylated to yield desmethyl diazepam. The antiepileptic effect of clorazepate was studied in 29 epileptic children with refractory seizures. Their ages were ranged from one year 9 months to 20 years (mean 11 years 6 months). Serum clorazepate levels were also determined in 16 patients. The mean initial dose was 0.91 mg/kg/day, and the dose was increased up to 3 mg/kg/day. Within several days after initiation of clorazepate therapy, a decrease in seizure frequency was seen in patients in whom clorazepate was effective. Excellent results (decrease in seizure frequency by more than 80%) were obtained in 7 patients (24.1%), a moderate improvement with a 50 to 80% decrease was seen in 7 patients (24.1%), and a partial improvement with less than 50% decrease was seen in 7 patients (24.1%). No benefit was seen in 8 patients (27.7%). Serum clorazepate levels in patients with excellent results were 31 to 77 ng/ml (mean 55 ng/ml), those in patients with a moderate improvement were 130 to 225 ng/ml (mean 163 ng/ml), and those in patients with a partial improvement were 142 to 518 ng/ml (mean 273 ng/ml). Serum clorazepate levels in patients with no benefit were 34 to 97 ng/ml (mean 56 ng/ml). There was no direct relationship between serum clorazepate levels and clinical response. The results of this study indicate the efficacy of clorazepate for epileptic children with refractory seizures.     

Comparisons of drug efficacy and time-effect among magnesium valproate, sustained-release magnesium valproate tablet and depakine chrono for epilepsy An experiment of determining cortical convulsive threshold In rats undergoing electrical stimulation

BACKGROUND: Scholars have investigated the differences in drug metabolism and pharmacodynamics between valproate and its sustained-release tablets only from the angle of pharmaceutical sciences or clinical practice. Whether the fact that differences in drug efficacy and time-effect of different doses of valproate and different types of sustained-release valproate tablets at the same concentration can be quantitatively reflected by determining the changes in convulsive threshold pre- and post-administration in rat models of determining the convulsive threshold developed by direct cortical electrical stimulation remains unclear. OBJECTIVE: This study aimed to compare the drug efficacy and time-effect among magnesium valproate, sustained-release magnesium valproate tablet and depakine chrono in the treatment of epilepsy by determining the convulsive threshold of rat models created by direct cortical electrical stimulation, and human serum drug concentration before and after administration. DESIGN: A controlled observational experiment. SETTING: Research Institute of Epilepsy, Shanxi Medical University. MATERIALS: Adult health male SD rats of clean grade, weighing 200–220 g, provided by the Laboratory Animal Center of Shanxi Medical University. The protocol was carried out in accordance with requests from Animal Ethics Committees for guidance. Magnesium valproate (Lot No. 041004) and sustained-release magnesium valproate tablet (Lot No. 050501) were produced in Hunan Xiangzhong Pharmaceutical Co., Ltd. METHODS: This study was carried out in the Laboratory for Epilepsy, Shanxi Medical University between June and August 2005. ①All the SD rats were created into models for determining cortical convulsive threshold. They were randomly divided into 4 groups with 20 rats in each: magnesium valproate tablet group , sustained-release magnesium valproate tablet group, depakine chrono group and control group. After being modeled, the rats in the first 3 groups were intragastrically administrated with magnesium valproate, sustained-release magnesium valproate tablet and depakine chrono, respectively, while the control group were intragastrically administrated with the same volume of normal saline. ②Convulsive threshold of each fasting rat was determined 0.5 hour before, and 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14 and 24 hours after single administration, separately. ③ Convulsive threshold was determined repeatedly 2 weeks after single administration. Each rat was administrated two times daily successively. Convulsive threshold was determined 0.5 hour before, and 0.5, 2.5, 7 and 12 hours after administration, separately. ④Hepatic and renal tissues were harvested for pathological examination after 1 month of administration. ⑤Nine healthy voluntary medical stuffs were recruited in this study. Written informed consents of experiment were obtained each involved subject. The study was given an approval by the Ethics Committee of Shanxi Medical University. According to the scheme, the 9 volunteers were randomly assigned into 3 groups, in which, volunteers were asked to take magnesium valproate 500 g, sustained-release magnesium valproate tablet 500 g and depakine chrono 500 g, respectively, in the morning under the condition of fasting. Serum drug concentration of each drug was determined by fluorescence polarization immunoassay at different time points. MAIN OUTCOME MEASURES: ① Rat convulsive threshold after single and repeated administrations. ②Hepatic and renal pathological examination results. ③ Serum drug concentration in vivo. RESULTS:①Rat convulsive threshold after single and repeated administrations: Drug efficacy in the magnesium valproate tablet group reached to a peak level 1 to 2 hours after single administration, and was obviously higher than that in the other groups 1 hour after administration (P < 0.05). Drug efficacy in the sustained-release magnesium valproate tablet group and depakine chrono group both reached to a peak level 7 hours after administration, and was significantly higher than that in the control group (P < 0.05). After repeated administrations, the average peak valley deviation of the convulsive threshold in the magnesium valproate tablet group was 120–150 μA, which was 2 and 2.5 times as that in the sustained-release magnesium valproate tablet group and depakine chrono group, respectively. After repeated administrations for 10 times, convulsive threshold was increased by 440μA in the sustained-release magnesium valproate tablet group, and by 230 μA in the depakine chrono group in comparison with before administration. ②Hepatic and renal pathological examination results: No obvious differences in hepatic and renal impairment were found among the 4 groups after 1 month of administration successively. ③ Serum drug concentration in vivo: Serum-drug concentration of magnesium valproate was increased fast and reached to a peak level 0.5–2 hours after administration, remained at a relatively stable level 2–4 hours after administration, and then was slowly decreased. The drug efficacy of sustained-release magnesium valproate tablet and depakine chrono was slowly released 1–6 hours after administration, reached to a peak level at about 7 hours, and could last for about 16 hours. CONCLUSION: Magnesium valproate has a rapid onset and offset of action. Sustained-release magnesium valproate tablet has a slow onset but long duration of drug efficacy. Depakine chrono can be easier to be absorbed than sustained-release magnesium valproate tablet, but its long-term effect on improving the convulsive threshold is inferior to sustained-release magnesium valproate tablet.     

Electropositive seizures and non‐convulsive status epilepticus in a critically ill patient with prior skull defect

Epileptiform discharges captured on routine scalp EEG typically carry a surface negative dipole. We present a patient whose continuous EEG recording in the intensive care setting captured frequent electropositive non‐convulsive seizures. Epileptiform discharges with positive polarity are common in the pediatric population but have rarely been reported in adult patients. When reported in adults, such patients usually have skull defects. As surface positive discharges are scarce, adult electroencephalographers should be prudent to differentiate such discharges from artifact, particularly in an intensive care setting where EEG artifact is common.     

Comparative steady state serum levels of valproic acid administered as two different formulations — Deprakine® and Orfiril®

Plain tablets of sodium valproate (VPA), a useful antiepileptic drug, are bitter tasting and produce gastric irritation which leads to poor patient compliance. We have studied the steady state serum levels of VPA which can be produced in epileptic patients before and after a 1 week treatment with a plain tablet (Deprakine) versus an enteric coated tablet (Orfiril). The latter drug produced in most patients a higher drug fasting blood level than the uncoated preparation (22%). The enteric coated tablets appeared also better tolerated.     

Amino acid metabolism in the brain with convulsive disorders. Part I: Free amino acid patterns in the brain of E1 mouse with convulsive seizure

To clarify the biochemical mechanism of convulsions from a view point of the amino acid metabolism, the free amino acid patterns in brains of El mice were investigated. The free amino acid levels in the brain excluding the cerebellum were measured by an amino acid autoanalyzer. 1) In the convulsion group, the free aspartic acid and serine levels in brains increased compared to the preconvulsion group. 2) In the postconvulsion group, an increase of glutamine and alanine levels in brains and a decrease of cystathionine level were found compared to the convulsion group. 3) It was found that in the preconvulsion group, the cystathionine and ornithine levels were high and the serine, alanine and GABA levels were low compared to the postconvulsion group. These results suggest that the free amino acid balance in the brain of this mouse should play an important role in the inducing mechanism of convulsions.     

丙戊酸和托吡酯对癫(癎)患儿游离肉毒碱的影响

目的探讨丙戊酸(VPA)和托吡酯(TPM)对癫癎患儿游离肉毒碱的影响。方法35例癫癎患儿,年龄6～8岁,男20例,女15例,其中12例予VPA单药治疗,11例予TPM单药治疗,12例予VPA及TPM联合治疗6～8个月。15例健康儿童作为正常对照组。测定血浆游离肉毒碱的浓度。结果VPA组血浆游离肉毒碱的浓度明显低于对照组及TPM组,VPA-plus- TPM组与VPA组比较差异无显著性,TPM组与对照组比较差异无显著性。结论VPA可降低癫癎患儿血浆游离肉毒碱水平,而TPM对血浆游离肉毒碱无明显影响。     

Effect of topiramate, in combination with lidocaine, and phenobarbital, in acute encephalitis with refractory repetitive partial seizures

Objective: Acute encephalitis with refractory repetitive partial seizure (AERRPS) is a peculiar type of post-encephalitic/encephalopathic epilepsy. Here we report an analysis of AERRPS in a series of children and propose an effective treatment option for seizure control in these children. Methods: We retrospectively reviewed cases of AERRPS treated in a pediatric intensive care unit, between February 2002 and June 2006. Clinical characteristics were systemically assessed. Burst suppression coma was induced by high-dose suppressive therapy; 24-h electroencephalogram (EEG) monitoring was performed on each patient. The goal of treatment was to achieve complete clinical seizure control or burst-suppression pattern on EEG, aiming for an interburst interval of >5 s. Brain imaging was done for each patient. Results: There were nine patients (seven boys), aged 5–15 years. Clinical symptoms included fever (100%), upper respiratory symptoms (66.7%) and altered consciousness (66.7%). All patients received multiple high-dose suppressive drugs and were intubated with/without inotropic agents. Seizures in three patients were stopped after high-dose lidocaine infusion (6–8 mg/kg/h) in the acute stage and three patients were stopped after high dose phenobarbital (serum level 60–80 ug/mL) combined with high-dose oral topiramate (15–20 mg/kg/day). Follow-up for this study was 16–61 months. Two subjects died while seven developed epilepsy and/or neurologic deficits; none returned to baseline. All survivors were discharged and continued multiple antiepileptic medications. Conclusions: Our data indicates that children with AERRPS have high mortality and morbidity rates. High-dose topiramate combined with high-dose lidocaine infusion or high-dose phenobarbital in the acute stage might be an effective treatment option for children with AERRPS.     

Cognitive effects of long-term treatment with phenobarbital and valproic acid in school children

The Wechsler Intelligence Scales for Children was applied to 64 epileptic children and 60 healthy subjects; patients followed chronic treatment with valproic acid (n = 32) or phenobarbital (n = 32). None of the children suffered mental retardation or neurological abnormalities. The test was repeated after a 9-12 month interval: 26 of the valproate treated children and 23 of the phenobarbital-treated children performed the second evaluation. At baseline, total, verbal and performance IQ scores of children receiving phenobarbital were lower than those of controls. When the results of the first and the second tests were compared, a significant increase in IQ scores was detected among controls and patients treated with valproic acid, but not among phenobarbital-treated patients. It is concluded that long-term phenobarbital therapy induces a significant impairment in learning ability whereas long-term valproate therapy does not exert a noticeable noxious effect at this respect.     

丙戊酸钠治疗小儿全面强直阵挛性发作相关认知功能障碍的影响因素分析

目的 探讨丙戊酸钠治疗全面强直阵挛性发作相关认知功能障碍的影响因素。方法 选取2017年1月至2019年5月在我院就诊的80例小儿全面强直阵挛性发作癫痫患者作为研究对象。所有患儿均给予丙戊酸钠治疗,后依据韦氏儿童智力量表（WlSC-CR）智商得分分为认知正常组（≥ 80分）和认知障碍组（<80分）。分析丙戊酸钠治疗3个月后认知功能障碍的影响因素。结果 两组患儿的发病年龄、每月发病频率、治疗剂量及疗程比较,差异有统计学意义（P<0.05）。回归分析显示,发病年龄<5岁、每月发病频率≥ 3次、治疗剂量≥ 35 mg/（kg·d）、治疗疗程≥ 6个月是丙戊酸钠治疗小儿癫痫后认知功能障碍的危险因素（P<0.05）。认知障碍组治疗3个月后每月发病频率、治疗剂量、治疗疗程与VIQ、PIQ、FIQ呈负相关（P<0.05）;发病年龄与VIQ、PIQ、FIQ呈正相关（P<0.05）。结论 发病年龄<5岁、每月发病频次≥ 3次、治疗剂量≥ 35 mg/（kg·d）、治疗疗程≥ 6个月是丙戊酸钠治疗小儿癫痫后认知功能障碍的危险因素。     

A serial analysis of serum aspartate aminotransferase levels in patients with acute encephalopathy with biphasic seizures and late reduced diffusion and prolonged febrile seizure

BackgroundThere are no established biomarkers for diagnosing acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) in the early acute phase, called “the 1st seizure phase”. Based on our clinical experience, we hypothesized that serial examinations of blood levels of aspartate aminotransferase (AST) in children with febrile convulsive status epilepticus (FCSE) revealed higher levels in patients with AESD in the 1st seizure phase than in those with prolonged febrile seizures (PFs).MethodsTo test our presented hypothesis, we retrospectively investigated changes in serum AST in patients with FCSE due to AESD (n = 11) or PFs (n = 27) who were serially examined within 48 h of the onset of convulsions.ResultsThe rate of increase in AST was significantly higher in patients with AESD than in those with PFs. The rate of increase in AST correlated with previously reported scoring systems, i.e., Yokochi and Tottori scores, for the prediction of AESD. A positive correlation between the rate of increase in AST and creatinine levels in the first examination were observed; however, creatinine levels did not significantly differ between the AESD and PFs groups in the first or second examination. Blood levels of pH, ammonia, and sugar in the first examination and C-reactive protein in the second examination were significantly higher in the AESD group than in the PFs group.ConclusionsThe present study revealed that the rate of increase in AST was significantly higher in patients with AESD than in those with PFs. A novel predictive scoring system needs to be established in combination with the rate of increase in AST and reported clinical parameters, which will improve the prognosis of patients with FCSE.     

The association between seizure clustering and convulsive status epilepticus in patients with intractable complex partial seizures

PURPOSE: We examined the association between seizure clustering and convulsive status epilepticus (SE) in patients with intractable complex partial seizures, to identify whether patients whose seizures typically cluster are at high risk for convulsive SE (CSE). METHODS: Seventy-six patients with intractable complex partial epilepsy who underwent presurgical evaluation in the Montefiore Epilepsy Management Unit from 1993 to 1997 were contacted and interviewed about typical seizure frequency and distribution and history of CSE. Seizure clustering was defined as three or more complex partial seizures within a 24-h period, with return to baseline between seizures. RESULTS: Of the 76 patients contacted, 21 (28%) had experienced at least one episode of CSE, and 36 (47%) typically experienced clustered seizures. SE occurred in 16 (44%) of 36 patients with clustered seizures, and in five (12.5%) of 40 patients with nonclustered seizures (p < 0.002). Of 53 patients with temporal lobe epilepsy, CSE occurred in 13 (50%) of 26 patients with clustered seizures, and four (14.8%) of 27 patients with nonclustered seizures (p < 0.006). CONCLUSIONS: Patients with intractable complex partial or localization-related epilepsy who typically experience seizure clustering are at a significantly higher risk for CSE than are patients with nonclustered seizures.     

Serum lipids, lipoproteins and apolipoproteins A and B in epileptic patients treated with valproic acid, carbamazepine or phenobarbital

Serum lipids, lipoproteins and apolipoproteins A and B were measured in 101 epileptic patients receiving chronic treatment with valproic acid, carbamazepine or phenobarbital and in 75 age- and sex-matched control subjects. In relation to controls, subjects treated with valproic acid showed significantly lower values of total and LDL-cholesterol levels; subjects treated with carbamazepine showed significantly higher values of HDL-cholesterol and apolipoprotein A concentrations and subjects treated with phenobarbital showed significantly higher values of total cholesterol, HDL-cholesterol, apolipoprotein A and apolipoprotein B levels. The total cholesterol/HDL-cholesterol ratio was significantly lower in patients receiving valproic acid or carbamazepine but not in the phenobarbital-treated group. Changes in serum lipids profile did not correlate with drug plasma concentrations nor the duration of the treatment.     

Amino acid metabolism in the brain with convulsive disorders. Part 2: The effects of anticonvulsants on convulsions and free amino acid patterns in the brain of El mouse

To elucidate the changes of free amino acid patterns in brains of El mice induced by several anticonvulsants, the free amino acid levels in brains were measured by an amino acid autoanalyzer 24 hours after intraperitoneal injection of PB, PHT or vitamin B6 or subcutaneous injection of ACTH. Compared to the preconvulsion group, the total free amino acid level increased in the ACTH group clearly. In the PB group, the levels of threonine, glutamine, lysine, histidine and homocarnosine increased and that of ornithine decreased; in the PHT group, an increase of glutamine and histidine and a decrease of beta-alanine and ornithine were observed; in the ACTH group, an increase of aspartic acid, threonine, serine, glutamic acid, glutamine, alanine and GABA and a decrease of cystathionine and ornithine were also observed; and in the vitamin B6 group, an increase of taurine and a decrease of cystathionine were recognized. These facts suggest that the sedative activity of these drugs except ACTH might be partially explained by the increase of inhibitory amino acids in the brain, such as glutamine, homocarnosine and taurine, and that of ACTH by the dehydration of the brain, resulting in concentration of many free amino acids.     

Argyria and convulsive seizures caused by ingestion of silver in a patient with schizophrenia

Abstract The case study of a schizophrenic patient with argyria which resulted from the chronic and excessive ingestion of antismoking pills contain silver, is presented. Convulsive seizures developed after the patient had been addicted to the pills for 40 years. An extremely high concentration of silver was detected in serum. This case provides support for the hypothesis that silver may cause convulsive seizures as a result of systemic poisoning.     

Long-term efficacy and safety of cannabidiol in patients with treatment-resistant epilepsies: Four-year results from the expanded access program

Objective

Cannabidiol (CBD) expanded access program, initiated in 2014, provided add-on CBD to patients with treatment-resistant epilepsies (TREs) at 35 US epilepsy centers. Prior publications reported results through December 2016; herein, we present efficacy and safety results through January 2019.

Methods

Patients received plant-derived highly purified CBD (Epidiolex®; 100 mg/ml oral solution), increasing from 2 to 10 mg/kg/day to tolerance or maximum 25–50 mg/kg/day dose, depending on the study site. Efficacy endpoints included percentage change from baseline in median monthly convulsive and total seizure frequency and ≥50%, ≥75%, and 100% responder rates across 12-week visit windows for up to 192 weeks. Adverse events (AEs) were documented at each visit.

Results

Of 892 patients in the safety analysis set, 322 (36%) withdrew; lack of efficacy (19%) and AEs (7%) were the most commonly reported primary reasons for withdrawal. Median (range) age was 11.8 years (range = 0–74.5), and patients were taking a median of three (range = 0–10) antiseizure medications (ASMs) at baseline; the most common ASMs were clobazam (47%), levetiracetam (34%), and valproate (28%). Median top CBD dose was 25 mg/kg/day; median exposure duration was 694 days. Median percentage reduction from baseline ranged 50%–67% for convulsive seizures and 46%–66% for total seizures. Convulsive seizure responder rates (≥50%, ≥75%, and 100% reduction) ranged 51%–59%, 33%–42%, and 11%–17% of patients across visit windows, respectively. AEs were reported in 88% of patients and serious AEs in 41%; 8% withdrew because of an AE. There were 20 deaths during the study deemed unrelated to treatment by the investigator. The most common AEs (≥20% of patients) were diarrhea (33%), seizure (24%), and somnolence (23%).

Significance

Add-on CBD was associated with sustained seizure reduction up to 192 weeks with an acceptable safety profile and can be used for long-term treatment of TREs.     

Effect of 5-fluoroindole-2-carboxylic acid (an antagonist of the NMDA receptor-associated glycine site) on the anticonvulsive activity of conventional antiepileptic drugs

Summary. 5-Fluoroindole-2-carboxylic acid, an antagonist of the glycine site within the NMDA receptor complex, administered intraperitoneally in doses of 150 and 200 mg/kg, 120 min before electroconvulsions, significantly raised the convulsive threshold from 6.8 to 7.9 and 8.3 mA, respectively. At lower doses, it did not influence the threshold. However, lethality was observed 24h after administration of the threshold-elevating doses of this glycine site antagonist. 5-Fluoroindole-2-carboxylic acid (100 mg/kg), applied together with carbamazepine, valproate or phenobarbital, significantly reduced their ED₅₀ values against maximal electroshock – from 13.9 to 7.5 mg/kg, from 291 to 242 mg/kg, and from 18.6 to 11.1 mg/kg, respectively. At the dose of 50 mg/kg, it also potentiated the protective activity of carbamazepine. However, 5-fluoroindole-2-carboxylic acid, up to 100 mg/kg, did not affect the anticonvulsive activity of diphenylhydantoin. When applied at doses equal to their ED₅₀ values against maximal electroshock-induced convulsions, carbamazepine (13.9 mg/kg), phenobarbital (18.6 mg/kg) and valproate (291 mg/kg) did not affect the motor performance of mice in the chimney test. 5-Fluoroindole-2-carboxylic acid (100 mg/kg) produced a significant motor impairment, at 50 mg/kg it did not affect the motor performance. The combined treatment of 5-fluoroindole-2-carboxylic acid (100 mg/kg) with carbamazepine, phenobarbital or valproate, providing a 50% protection against maximal electroshock, resulted in motor impairment. Only the combination of 5-fluoroindole-2-carboxylic acid (50 mg/kg) with carbamazepine (8.6 mg/kg) did not significantly influence this parameter. Almost all of the antiepileptic drugs studied, when administered at doses equal to their ED₅₀ values against maximal electroshock, did not influence retention in the passive avoidance task, which is a measure of long-term memory. Only valproate (291 mg/kg) worsened long-term memory. The combined treatment of 5-fluoroindole-2-carboxylic acid (100 mg/kg) with carbamazepine or phenobarbital, providing a 50% protection against maximal electroshock, did not affect the retention. The combination of 5-fluoroindole-2-carboxylic acid (100 mg/kg) with valproate (242 mg/kg) caused a significant impairment of long-term memory and mortality of 50% of animals 24 h following the administration. The results suggest that the blockade of the strychnine-insensitive glycine site may lead to an enhancement of the protective activity of some conventional antiepileptic drugs, which is associated with pronounced side-effects and lethality in some cases. Accepted January 9, 1998; received July 28, 1997     

Low antioxidant status of serum uric acid,bilirubin and albumin in patients with neuromyelitis optica

Background: Oxidative stress plays a central role in neuropathology of multiple sclerosis (MS). The patients with MS have low antioxidant status. Antioxidant therapy may represent an attractive treatment of MS. However, the relationship between neuromyelitis optica (NMO), a distinct nosologic entity or a form of MS, and antioxidant status has not fully been investigated. Objectives: To investigate the correlation between NMO and serum antioxidant status of uric acid (UA), bilirubin and albumin. Methods: The serum levels of antioxidant molecules UA, bilirubin (Tbil and Ibil) and albumin were measured in 236 individuals comprising healthy subjects and patients with NMO or MS. Results: We found that serum levels of UA, Tbil, Ibil and albumin in patients with NMO were significantly lower than those in healthy control group. Moreover, these results were also observed when the male and female cohorts were investigated separately. Likewise, the serum levels of UA, Tbil, Ibil and albumin in patients with NMO were also lower than those of patients with MS. In all groups, women had lower serum UA, Tbil, Ibil and albumin levels than men. In UA groups, women had significantly lower serum UA levels than men. Conclusion: We concluded that there were reducing serum levels of UA, bilirubin and albumin in patients with NMO. The study showed patients with NMO had low antioxidant status. As a replacement therapy to patients, administration of albumin, bilirubin and UA or theirs precursors, such as inosine of UA precursor, may be beneficial to the patients with NMO.