左乙拉西坦单药治疗80例成人癫癎的疗效及安全性

目的：评价左乙拉西坦单药治疗各种类型成人癫癎的疗效和安全性.方法：80例各类型新诊断的成人癫癎患者,口服左乙拉西坦治疗,随访1年,观察治疗后患者癫癎发作次数变化及不良反应发生率.结果：左乙拉西坦单药治疗成人癫癎的总有效率为75.0%;对部分性发作可能更为有效,有效率为77.08 %;不良反应发生率为16.3%.因疗效不佳退出为18.75%.结论：在单药治疗成人癫癎中,左乙拉西坦是一种安全有效的抗癫药物,且对部分性和全面性癫癎发作均有效.     

左乙拉西坦单药治疗各型癫癎的疗效和安全性临床观察

目的对50例单独应用左乙拉西坦（LEV）的癫癎患者进行临床观察和随访,以评估左乙拉西坦治疗各型癫癎的疗效和安全性。方法采用开放性自身对照方法对2009年6月~2010年3月本院及其门诊就诊的50例左乙拉西坦单药治疗的癫癎患者进行随访研究,收集治疗前后患者发作频率变化、发作情况、不良反应以及退出原因。其随访均在半年以上。结果 LEV单药治疗后癫癎发作完全控制率48%,有效率38%;其中部分性发作完全控制率40.9%,有效率45.5%;全面性发作完全控制率53.6%,有效率32.1%,对west综合症亦有效。不良反应包括情绪异常、易激惹12%（6/50）,头晕8%（4/50）,白细胞减少2%（1/50）;上述不良反应均为一过性,在2~5周内自然消失,未导致停药,未发现过敏以及肝、肾功能异常等严重不良反应。结论 LEV是一种安全有效的抗癫癎药物,对部分性和全面性发作均有效,且安全耐受性较好。     

左乙拉西坦治疗儿童癫(癎)的疗效观察

目的 观察左乙拉西坦(Lev)治疗儿童癫(癎)的疗效.方法 62例癫(癎)患儿(9个月～14岁)根据病情分为Lev单药治疗组(34例)和添加治疗组(28例).Lev的起始剂量为10～20 mg/(kg·d),分两次服用,每1～2周增加10 mg/(kg·d),在4周内增加至27～46 mg/(kg·d),持续服用6个月.观察治疗过程中癫(癎)发作频率、脑电图变化及不良反应;治疗6个月时评定疗效.结果 本组的总有效率和控制率为64.5%和29.0%.单药治疗组和添加治疗组总有效率分别为76.5%及50.0%,完全控制率分别为41.2%及14.3%,两组间差异有统计学意义(P＜0.05～0.01).治疗前13例脑电图出现睡眠中癫(癎)性电持续状态(ESES),治疗后7例消失.22例(35.5%)出现不良反应,表现为食欲下降、呕吐、思睡、头痛头昏、情绪及行为异常,均自行缓解.结论 无论单药还是添加治疗,Lev对儿童癫(癎)均有显著疗效,对ESES有部分改善作用;不良反应轻.     

左乙拉西坦单药治疗脑梗死后迟发性癫癎的临床观察

目的:观察左乙拉西坦对老年脑梗死后迟发性癫癎的疗效和安全性。方法:左乙拉西坦单药治疗新诊断的老年脑梗死后迟发性癫癎18例,起始剂量250mg,每日2次。根据疗效调整剂量,每日最大量不超过3000mg。观察癫癎发作的频率、类型及不良反应。结果:18例迟发性癫患者应用左乙拉西坦500～1500mg·d-1后有16例(88.9%)未再有癫癎发作。3例(16.7%)有嗜睡,2例(11.1%)有头昏表现,不良反应总发生率为27.8%(5/18例)。上述不良反应均未经特殊处理,在l～2个月自行消失,无一例因不良反应退出治疗。结论:左乙拉西坦是治疗老年缺血性脑卒中后迟发性癫安全、有效,而且耐受性良好的药物。     

左乙拉西坦治疗癫（癎）伴认知功能障碍患儿疗效观察

目的 分析左乙拉西坦治疗癫（癎）伴认知功能障碍患儿的临床疗效.方法 选择在本院接受治疗的癫（癎）伴认知功能障碍患儿作为研究对象,分别给予常规治疗及左乙拉西坦治疗,比较2组患儿的认知功能、脑电活动情况及生活质量评分等差异.结果 观察组总有效率（66.67%）、MMES评分（25.47±4.83）、无认知功能障碍（83.33%）、躯体功能（76.87±7.16）、心理功能（59.32±5.34）、社会功能（58.76±2.16）、总体生活质量（82.34±8.21）评分均明显高于对照组（P〈0.05）;癫（癎）样放电（15%）、α波（18.21±3.36）、β波（10.32±2.25）、δ（12.36±2.25）、θ波（20.32±3.24）数目均明显少于对照组（P＜0.05）.结论 左乙拉西坦可有效改善癫（癎）伴认知功能障碍患儿的认知功能,减少异常脑电活动,提高生活质量.     

左乙拉西坦添加治疗对难治性部分性癫(癎)患者生活质量影响的研究

目的:评价新型抗癫药物左乙拉西坦(Lev)作为添加治疗对难治性部分性癫患者生活质量的影响。方法:43例确诊有癫部分性发作的成年患者随机分为两组:Lev治疗组与安慰剂组,Lev治疗16周后比较两组的有效率和不良反应,并用QOLIE-31量表对两组癫患者进行生活质量评定,所有患者在转入Lev开放性治疗6个月后再次进行QOLIE评估。结果:16周治疗期末Lev组癫部分性发作的治疗有效率明显高于安慰剂组,两组不良反应的发生率相当;Lev组生活质量明显高于安慰剂组,两组患者转入开放性治疗6个月后,生活质量均显著改善。结论:Lev作为添加用药治疗成人难治性部分性癫发作,显著减少发作频率、安全耐受性较好,能够提高癫患者的生活质量。     

左乙拉西坦治疗青少年肌阵挛癫(癎)初步探讨

目的:探讨左乙拉西坦(LEV)对青少年肌阵挛性癫(癎)(JME)的疗效.方法:30例JME患者中,男16例,女14例,平均年龄19.63岁,分为两组.LEV治疗组 15例,单用4例,与丙戊酸或(和)氯硝西泮合用11例,治疗剂量500～1 000 mg/d.随访时间2个月至9年,平均19.20个月;其他药物治疗组15例,...     

左乙拉西坦在儿童癫中的应用

左乙拉西坦是一种新型抗癫药物,由于其不良反应少、安全性高,已广泛应用于儿童局灶性及全面性癫的治疗。本文对左乙拉西坦在儿童癫及儿童癫综合征中单药及添加使用的疗效及安全性做一综述。     

左乙拉西坦单药治疗各类癫痈的疗效

左乙拉西坦是一种新型作用机制的抗癫痫药物,其抗痢机制可能是通过影响突触囊泡蛋白SV2A来实现。本文就该药物单一治疗各类癫痫（新诊断癫痫、部分性发作、全面性发作及手术后癫痫等）的疗效和耐受性研究做介绍。     

左乙拉西坦治疗各型癫(癇)100例临床疗效观察

目的 观察左乙拉西坦(开普兰)治疗各型癫(癇)的疗效.方法 用开放性试验的方法对100例癫(癇)患者进行了添加转单药以及首诊单药的开普兰治疗,观察其疗效及不良反应.结果 总有效率46.0%,控制率15.0%,对各型癫(癇)均有效.不良反应出现率17.0%.结论 开普兰是一种安全、有效的抗癫(癇)药物,对各型癫(癇)均有效.     

左乙拉西坦治疗难治性癫痫48例的临床研究

目的：探讨左乙拉西坦（Lev）添加剂量治疗难治性癫痫的疗效和安全性。方法：采用开放性自身对照方法,对48例（儿童23例,成人25例）难治性癫痫患者进行Lev添加治疗,并随访1年以上,收集治疗后患者发作频率变化、无发作情况、不良反应以及退出原因。结果：Lev治疗难治性癫痫总有效率为64．58％,成人有效率高于儿童,对部分性癫痫综合征有效率高;3、6和12个月无发作率分别为6．25％、18．75％和16．67％,保留率为81．25％、56．25％和43．75％。总不良反应发生率为39．58％,无严重不良反应,退出的最主要原因为对疗效欠满意。结论：LEV是一种安全有效的难治性癫痫治疗药物,对部分性和全面性癫痫发作均有效。     

Increased EEG Current-Source Density in the High Beta Frequency Band Induced by Levetiracetam Adjunctive Therapy in Refractory Partial Epilepsy

Background and Purpose

Levetiracetam (LEV) is an antiepileptic drug (AED) that has favorable effects on cognition. Although neuropsychological studies have demonstrated these favorable outcomes on cognition, there are few electrophysiologic data describing the functional changes exerted by LEV. The purpose of this study was to determine the effects of LEV adjunctive therapy on the current-source density (CSD) in the high beta frequency band (22-30 Hz) of EEG background activity in refractory partial epilepsy (RPE).

Methods

We conducted a 24-week, open-label, prospective study in 24 patients with RPE. Scalp electroencephalography and neuropsychological tests (NPTs) were conducted twice, once before the LEV trial and then again after 24 weeks of medication.

Results

The CSD in the 22-30 Hz band of EEG background activity increased in the bilateral anterior cingulate gyri, left parahippocampal gyrus, and a small area of the right anterior parahippocampal gyrus after the LEV trial. Neither seizure freedom nor the dosage increment of LEV elicited meaningful CSD changes. Verbal memory and executive function were improved after the 24-week LEV trial.

Conclusions

To our knowledge, this is the first study to examine the changes in CSD induced by LEV adjunctive therapy in RPE patients. The CSD changes and NPT results suggest that LEV enhances the activities of the neuronal networks in the prefrontal cortex and left hippocampus.     

Psychiatric Symptoms and Quality of Life in Patients with Drug-Refractory Epilepsy Receiving Adjunctive Levetiracetam Therapy

Background and Purpose

Levetiracetam (LEV) is a new antiepileptic drug that has been found to be effective as an adjunctive therapy for uncontrolled partial seizures. However, the results of several studies suggested that LEV has negative psychotropic effects, including irritability, aggressiveness, suicidality, and mood disorders. We investigated the impact of adjunctive LEV on psychiatric symptoms and quality of life (QOL) in patients with drug-refractory epilepsy (DRE) and determined the risk factors provoking psychiatric adverse events.

Methods

A 24-week, prospective, open-label study was conducted. At enrollment, we interviewed patients and reviewed their medical charts to collect demographic and clinical information. They were asked to complete self-report health questionnaires designed to measure various psychiatric symptoms and QOL at enrollment and 24 weeks later.

Results

Seventy-one patients were included in the study, 12 patients (16.9%) of whom discontinued LEV therapy due to serious adverse events including suicidality. The risk factor for premature withdrawal was a previous history of psychiatric diseases (odds ratio 4.59; 95% confidence interval, 1.22-17.32). LEV intake resulted in significant improvements in Beck Anxiety Inventory score (p<0.01) and some domains of the Symptom Checklist-90-Revised, such as somatization (p<0.05), obsessive-compulsiveness (p<0.05), depression (p<0.05), and anxiety (p<0.05). These improvements were not related to the occurrence of seizure freedom. The Quality of Life in Epilepsy Inventory-31 overall score and subscale scores, such as seizure worry (p<0.01), overall QOL (p<0.05), emotional well-being (p<0.05), energy-fatigue (p<0.05), and social function (p<0.05), also improved.

Conclusions

Adjunctive LEV in patients with DRE is likely to improve psychiatric symptoms and QOL. Clinicians should be well aware of the psychiatric histories of patients to prevent them from developing serious adverse events related to LEV.     

Correlation Between Efficacy of Levetiracetam and Serum Levels Among Children With Refractory Epilepsy

BackgroundLevetiracetam is used as adjunctive therapy in various types of seizures. Studies evaluating the effect of levetiracetam on children with refractory epilepsy are scarce. The aim of this study was to evaluate the correlation between serum concentration of levetiracetam and either efficacy or tolerability in children with refractory epilepsy, and to determine the value of levetiracetam blood level monitoring.MethodsMedical records of 50 children with refractory epilepsy treated with levetiracetam and regularly followed at Assaf Harofeh Medical Center were retrospectively reviewed. Trough serum levetiracetam concentration was determined using high-performance liquid chromatography and correlated with the administered dose and clinical report.ResultsNo correlation between levetiracetam serum levels and clinical efficacy, tolerability or administered dosage was found. The average dose of levetiracetam was 43.7 ± 20.0 (range 14-100) mg/kg/day and the average serum concentration was 16.0 ± 9.5 (range 2.5-38.5) μg/mL. Forty-five patients (95%) had more than a 50% reduction of seizure frequency, with 22 (44%) patients becoming seizure-free for at least 6 months. Adverse events related to levetiracetam were reported in 15 (30%) patients. No correlation between serum concentrations and adverse events was found. These results were not affected by gender, age, type of seizure, and other drugs.ConclusionsDetermination of serum concentration is not needed in all children treated with levetiracetam. Serum concentrations may be valuable either in patients with refractory epilepsy for compliance evaluation or in patients with satisfactory control of seizures for determination of their therapeutic baseline.     

左乙拉西坦添加治疗肌阵挛-失张力癫癇4例报道

目的：探讨左乙拉西坦添加治疗肌阵挛-失张力癫癇（MAE）的有效性及安全性。方法：回顾分析4例左乙拉西坦添加治疗的MAE病例,并结合国外相关文献分析其有效性和安全性。结果：4例MAE患者添加左乙拉西坦治疗后癫癇发作均明显减少,其中3例完全无发作,最长无发作时间达6个月,并且无明显不良反应。结论：左乙拉西坦添加治疗MAE可能是一较好的治疗方案。     

左乙拉西坦治疗儿童癫痈完全控制及其影响因素的研究

目的：研究左乙拉西坦治疗儿童癫痫疗效达完全控制及其影响因素,为临床合理使用左乙拉西坦,使其效果最大化提供依据。方法：采用前瞻性研究,按纳入及排除标准纳入病例;疗程≥3个月,统计完全控制率;对完全控制组和非完全控制组患者进行不同发作类型、治疗方案、年龄及病因等对照研究。结果：共纳入癫痫患儿110例,其中完全控制56例（50．9％）。不同发作类型、病因及不同治疗方案的完全控制率比较差异有统计学意义（P〈0．05）。结论：左乙拉西坦治疗儿童癫痫有较高的完全控制率,完全控制率与发作类型、治疗方案及病因有关。     

Levetiracetam monotherapy for childhood occipital epilepsy of gastaut

Objectives – The aim of this open label pilot study was to evaluate the efficacy and tolerability of levetiracetam (LEV) as ‘de novo’ monotherapy in children and adolescents with late onset childhood occipital epilepsy–Gastaut type (COE‐G). Material and methods – Twelve patients suffering from COE‐G were enrolled in this prospective study. The age of seizures onset ranged from 6.1 to 16.2 years with a peak of frequency at mean (±SD) 10.54 ± 2.77 years. Therapy with LEV was started at 10 mg/kg/day and, after titration, the final dose was generally achieved within 4 weeks and ranged from 20.7 to 45.2 mg/kg/day. Results – At the 6 month evaluation, 11 (91.6%) of the 12 patients studied were seizure free, and one (8.3%) showed four additional episodes. Electroencephalography (EEG) activity was normal in six (54.5%) patients, unchanged in two (18.1%) children, and in four (33.3%) patients sporadic occipital abnormalities persisted. At the 12‐month evaluation all patients were completely seizure free. Four patients (33.3%) continued to show some EEG abnormalities, while eight (72.8%) patients had normal EEG. At the 18‐month evaluation all patients were seizure free and 10 patients (83.3%) showed a complete normalization of EEG abnormalities. Discussion – Monotherapy with LEV was effective and well tolerated in patients with COE‐G. Nevertheless, prospective, large, long‐term double‐blind studies are needed to confirm these findings.     

Levetiracetam in the treatment of epilepsy

Epilepsy is a common chronic disorder that requires long-term antiepileptic drug therapy. Approximately one half of patients fail the initial antiepileptic drug and about 35% are refractory to medical therapy, highlighting the continued need for more effective and better tolerated drugs. Levetiracetam is an antiepileptic drug marketed since 2000. Its novel mechanism of action is modulation of synaptic neurotransmitter release through binding to the synaptic vesicle protein SV2A in the brain. Its pharmacokinetic advantages include rapid and almost complete absorption, minimal insignificant binding to plasma protein, absence of enzyme induction, absence of interactions with other drugs, and partial metabolism outside the liver. The availability of an intravenous preparation is yet another advantage. It has been demonstrated effective as adjunctive therapy for refractory partial-onset seizures, primary generalized tonic-clonic seizures, and myoclonic seizures of juvenile myoclonic epilepsy. In addition, it was found equivalent to controlled release carbamazepine as first-line therapy for partial-onset seizures, both in efficacy and tolerability. Its main adverse effects in randomized adjunctive trials in adults have been somnolence, asthenia, infection, and dizziness. In children, the behavioral adverse effects of hostility and nervousness were also noted. Levetiracetam is an important addition to the treatment of epilepsy.