左乙拉西坦单药治疗小儿癫痫的自身对照研究

目的研究左乙拉西坦作为单药治疗不同类型癫痫患儿的临床疗效和安全性。方法采用前瞻性研究,对62例不同类型癫痫患儿进行左乙拉西坦单药治疗。左乙拉西坦起始剂量为20 mg/(kg.d),分两次服用,每两周增加10 mg/(kg.d),维持剂量30～40 mg/(kg.d)。稳定期:维持加量期12周,每个月观察1次,以治疗前3个月的发病频率为基础,完成了6个月的观察期,随访6～24个月(平均随访12.8个月),观察发作频率的变化及不良反应。结果 62例入选患儿,完全控制发作38例,占61.3%,显效8例,占12.9%;有效9例,占14.5%;无效4例,占6.5%;加重3例,占4.8%。总有效率为88.7%,两年治疗保留率为72%。左乙拉西坦治疗前后发作频率改变有统计学意义(P0.005)。结论左乙拉西坦作为单药治疗小儿各型癫痫有良好疗效及安全性。     

左乙拉西坦添加治疗成人癫痫部分性发作的效果观察

癫痫部分性发作是一种常见的癫痫发作类型,对人体的危害较大[1]。近年来,左乙拉西坦作为一种抗癫痫新药,主要用于癫痫患者部分性发作的加用治疗,在治疗成人癫痫部分性发作的过程中获得较好的效果。本研究选择104例成人癫痫部分性发作患者,探讨左乙拉西坦添加治疗成人癫痫部分性发作的临床效果,现报告如下。1资料和方法1.1一般资料从我院2011-05—2013-05收治的成人癫痫     

左乙拉西坦添加治疗难治性癫癎的疗效和安全性分析

目的:探讨左乙拉西坦添加治疗难治性癫痫的疗效和安全性。方法:回顾性分析了35例左乙拉西坦添加治疗的难治性癫痫患者,随访3～18个月,观察其疗效及不良反应。结果:左乙拉西坦添加治疗难治性癫痫总有效率为48.6%,对部分性发作和全面性发作的疗效无显著差异。不良反应发生率为31.5%,无严重不良反应。结论:左乙拉西坦是一种安全有效的难治性癫痫治疗药物,可以用于难治性癫痫的添加治疗。     

左乙拉西坦和丙戊酸钠对青少年肌阵挛癫痫单药治疗的疗效比较

目的比较左乙拉西坦(levetiracitam,LEV)和丙戊酸钠(sodium valproate,VPA)对青少年肌阵挛癫痫(Juvenile Myoclonic Epilepsy,JME)单药治疗的疗效。方法选取60例青少年肌阵挛癫痫患者,随机分为2组,每组30例,分别给予左乙拉西坦和丙戊酸钠单药治疗,比较治疗后2组肌阵挛发作(myoclonic seizure,MS)、全面性强直阵挛发作(generalized tonic-clonic seizure,GTCS)和脑电图(electroencephalogram,EEG)改善情况。结果 (1)肌阵挛发作改善情况:左乙拉西坦组总有效率为79.31%,丙戊酸钠组总有效率为85.71%(χ2=0.049,P0.05);(2)全面性强直阵挛发作改善情况:左乙拉西坦组总有效率为89.65%,丙戊酸钠组有效率为82.14%(χ2=0.669,P0.05);(3)脑电图改善情况:左乙拉西坦组总有效率为72.41%,丙戊酸钠组总有效率为75.00%(χ2=0.049,P0.05);(4)不良反应:左乙拉西坦组不良反应发生率为6.90%,丙戊酸钠组为25.00%(χ2=6.02,P0.05)。结论青少年肌阵挛癫痫是一种需要长期治疗甚至终生治疗的疾病,故选择治疗药物时不仅需要考虑疗效,长期服用药物的毒副作用也不容忽视。左乙拉西坦和丙戊酸钠对青少年肌阵挛癫痫单药治疗有相同的疗效,且左乙拉西坦不良反应发生率较丙戊酸钠小(P0.05),故左乙拉西坦可作为治疗青少年肌阵挛癫痫的首选一线药物。     

左乙拉西坦在癫痫治疗中的作用

左乙拉西坦是目前近年应用于临床的新型抗癫痫药物之一。其有理想的药物代谢动力学特征和独特于传统抗癫痫药物的抗癫痫作用机制,现已成为4岁以上儿童、青少年及成人部分性发作癫痫的优选添加治疗药物之一。近来左乙拉西坦的适应证进一步扩大,在多种发作形式的癫痫治疗中展现出良好的应用前景,本文对其抗癫痫作用的研究进展做一综述。

     

癫痫住院患者抗癫痫药物和病因及发作形式的回顾性研究

目的了解癫痫住院患者病因、发作形式及抗癫痫药使用情况。方法收集癫痫住院患者5563例,分析其病因、发作形式及抗癫痫药物的种类、数量及使用频度。结果病因不明(40.80%),脑外伤(13.64%)、海马硬化(11.52%)、脑卒中(5.24%)、神经系统感染(4.98%)、围生期损害(5.28%)等为常见病因,发作形式以部分性发作最常见(45.43%),抗癫痫药物以传统药物卡马西平和丙戊酸为主,卡马西平和丙戊酸平均使用率分别为36.88%和30.80%,新型抗癫痫药物拉莫三嗪和左乙拉西坦使用频度呈上升趋势,拉莫三嗪从16.16%上升到28.44%,左乙拉西坦从0.61%上升到20.87%,奥卡西平和托吡酯的使用频度变化不明显,分别稳定在15.07%和9.42%左右。结论癫痫病因复杂,发作形式多样,抗癫痫药物种类繁多,新型抗癫痫药物在临床中越来越多的被使用。     

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.     

脑卒中后癫痫药物修饰治疗进展

脑卒中后癫痫患者对低剂量抗癫痫发作药物治疗反应良好,但仍有部分患者进展为耐药性癫痫,因此亟待研发有效预防或逆转癫痫发生和发展且具备疾病修饰治疗作用的药物。业已证实,左乙拉西坦、拉莫三嗪、唑尼沙胺等新型抗癫痫发作药物,大麻二酚、多酚类化合物等天然化合物,线粒体抗氧化药、非甾体抗炎药等药物不仅能控制癫痫发作,甚至能够阻止脑卒中后癫痫的发生,以此发挥抗癫痫发生及疾病修饰治疗作用。本文对具有疾病修饰治疗作用的药物进行归纳,以为脑卒中后癫痫的疾病修饰治疗提供新的研究思路。     

左乙拉西坦在癫痫治疗中的作用

详细总结新型抗癫痫药物左乙拉西坦的药物代谢动力学特点、药物相互作用、抗癫痫作用机制、对成人及儿童各种不同发作类型癫痫的添加治疗及单药治疗研究进展、安全性评价及常见不良反应、特异质性不良事件、认知功能及生活质量影响。结论该药具有理想的药动学特性、较高的安全性及抗癫痫效能,对认知功能无明显损害,适应证扩大后已经可用于16岁以上人群部分性发作癫痫的单药治疗、全面性发作癫痫中某些特定发作类型的添加治疗。     

左乙拉西坦与精神行为异常

癫痫作为一种古老的疾病,在全世界有广泛的发病人群,其对于个人、家庭、社会都有严重的负面影响。左乙拉西坦作为第二代抗癫痫药物,因其相对高安全性、药代动力学简单及与其他药物相互作用的发生率低等特点,在临床上广泛应用。虽然左乙拉西坦在控制癫痫发作方面疗效显著,但在使用过程中会出现多种不良反应,如头晕、共济失调,以及包括抑郁、焦虑、情绪不安甚至自杀等精神行为异常。该文主要就左乙拉西坦导致精神行为异常的可能机制、影响因素等方面进行综述,并对临床应用提出建议。     

Accelerated cognitive decline in a rodent model for temporal lobe epilepsy

ObjectiveCognitive impairment is frequently observed in patients with temporal lobe epilepsy. It is hypothesized that cumulative seizure exposure causes accelerated cognitive decline in patients with epilepsy. We investigated the influence of seizure frequency on cognitive decline in a rodent model for temporal lobe epilepsy.MethodsNeurobehavioral assessment was performed before and after surgery, after the induction of self-sustaining limbic status epilepticus (SSLSE), and in the chronic phase in which rats experienced recurrent seizures. Furthermore, we assessed potential confounders of memory performance.ResultsRats showed a deficit in spatial working memory after the induction of the SSLSE, which endured in the chronic phase. A progressive decline in recognition memory developed in SSLSE rats. Confounding factors were absent. Seizure frequency and also the severity of the status epilepticus were not correlated with the severity of cognitive deficits.SignificanceThe effect of the seizure frequency on cognitive comorbidity in epilepsy has long been debated, possibly because of confounders such as antiepileptic medication and the heterogeneity of epileptic etiologies. In an animal model of temporal lobe epilepsy, we showed that a decrease in spatial working memory does not relate to the seizure frequency. This suggests for other mechanisms are responsible for memory decline and potentially a common pathophysiology of cognitive deterioration and the occurrence and development of epileptic seizures. Identifying this common denominator will allow development of more targeted interventions treating cognitive decline in patients with epilepsy. The treatment of interictal symptoms will increase the quality of life of many patients with epilepsy.     

立体定向毁损杏仁海马复合体治疗癫痫长期随访

目的 探讨立体定向射频毁损杏仁海马复合体，能否阻止癫痫放电的传播以治疗顽固性癫痫。方法 17例顽固性癫痫病人应用ZD立体定向系统，CT扫描确定杏仁核和海马的靶点，分别毁损杏仁核和海马。术后常规MR复查了解靶点毁损的部位和大小，并排除并发症。结果 本组17例，无手术并发症。随访2～6年，平均3年9个月，结果满意者7例(癫痫发作消失)，显著改善者7例(癫痫发作减少75％)，无效者1例，1例自行停药2月后，癫痫发作又复发，再次服药后仍有癫痫发作。所有患者均需服药，药量无明显减少。结论 立体定向射频毁损杏仁海马复合体治疗癫痫，创伤小，安全，控制癫痫发作基本满意，长期有效。     

Marital status after epilepsy surgery

PURPOSE: To characterize features influencing marital status in a group of patients with refractory epilepsy before and after epilepsy surgery and to assess the effect of seizure control on marital status after epilepsy surgery. METHODS: We analyzed marital status in 430 epilepsy surgery patients and in a subset with temporal lobe epilepsy. Marital status was assessed in relation to gender and age of epilepsy onset and compared with marital rates for the U.S. population. Patients who had > or =4 years of postsurgical follow-up were examined for change in marital status after surgery. Those patients who changed marital status were then evaluated for change in employment. RESULTS: Marital rates were lower than expected in men. Men with onset of epilepsy by age 11 years were less likely to be married than men whose seizures began after age 11 or women whose seizures began at any age. Men and women with temporal lobe epilepsy had higher marriage rates than those with extratemporal lobe epilepsy. More than 4 years after epilepsy surgery (n = 190), patients who had no recurrent seizures were more likely to change marital status (28 of 124, 23%), than those who had recurrent seizures (five of 66, 8%). Seizure-free women were more likely to divorce (n = 9) than were seizure-free men (n = 1). Most men who married were employed (77%), whereas women who divorced were usually unemployed (67%). CONCLUSIONS: The age at which seizures begin influences later marital status in men, who have reduced marriage rates. The abolition of seizures by epilepsy surgery creates new opportunities for changing social relationships. Location of the epileptic focus may influence psychosocial function.     

Localized Cerebellar Hypometabolism in Patients with Complex Partial Seizures

Summary: Purpose : We sought to determine the cause of cerebellar dysfunction in epilepsy and whether this dysfunction was directly related to seizures.
Methods : Cerebellar metabolism was evaluated in 48 patients with a well-defined region of seizure onset and with corresponding hypometabolism. Regions of interest (ROI) were drawn according to a standardized template. If the ROI/honepileptogenic cortex count rate ratio was outside the 95% confidence interval (CI) of controls, the ROI was defined as abnormal. The ratios from cerebellar hemispheres (defined as ipsi- or contralateral to the seizure onset region), were compared among controls (n = 8); patients who had seizure onsets and corresponding hypometabolism mesially in a temporal lobe (patient group 1, n = 19); patients whose seizures had onset mesially in a temporal lobe but spread rapidly to the ipsilateral frontal lobe and who had hypometabolism both in the affected temporal lobe and frontal lobe (patient group 2, n = 23); and patients who had seizure onsets and corresponding hypometabolism in the frontal lobe (patient group 3, n = 6).
Results : Significant hypometabolism was noted in the contralateral cerebellum of patients in groups 2 and 3 [p = 0.007 and p = 0.008, respectively; two-way analysis of variance (ANOVA)]. In contrast, patients in group 1 tended to have lower values in the ipsilateral cerebellum (p = 0.057).
Conclusions : The observed cerebellar changes are consistent with animal data showing that cerebellar connections to frontal lobes are numerous and crossed, whereas the connections to mesial temporal lobes are less abundant, bilateral, with an ipsilateral predominance. The difference between the two groups of patients with mesial temporal seizures suggests that cerebellar dysfunction in partial epilepsy, at least to a certain extent, is related to mechanisms involved in seizure generation and spread.     

Transplantation of bone marrow mononuclear cells decreases seizure incidence, mitigates neuronal loss and modulates pro-inflammatory cytokine production in epileptic rats

Approximately 30% of patients with mesial temporal lobe epilepsy do not respond to treatment with antiepileptic drugs. We have previously shown that transplantation of mononuclear bone marrow cells (BMC) has an anticonvulsant effect in acute epilepsy. Here, we used pilocarpine to induce epilepsy in rats and studied the effects of BMC injected intravenously either at the onset of seizures or after 10 months of recurrent seizures. BMC effectively decreased seizure frequency and duration. In addition, decreased levels of proinflammatory cytokines (TNF-α, IL-1β and IL-6) and increased levels of anti-inflammatory cytokine (IL-10) were observed in the brain and serum of BMC-treated rats. Transplants performed at seizure-onset protected against pilocarpine-induced neuronal loss and gliosis and stimulated the proliferation of new neurons in epileptic rats. Our data demonstrate that BMC transplantation has potent therapeutic effects and could be a potential therapy for clinically intractable epilepsies.     

Seizure recurrence after planned discontinuation of antiepileptic drugs in seizure-free patients after epilepsy surgery: a review of current clinical experience

PURPOSE: Although epilepsy surgery, especially temporal lobe epilepsy surgery, is well established to control seizures in patients remaining on antiepileptic drug (AED) treatment, less information is available about how many seizure-free surgical patients will relapse after discontinuation of AEDs under medical supervision. METHODS: A literature review yielded six retrospective clinical observations. RESULTS: After planned discontinuation of AEDs in patients rendered seizure free after epilepsy surgery, most often various forms of temporal lobe surgery, the mean percentage recurrence rate in adults in four studies was 33.8%[95% confidence interval (CI), 32.4-35.2%], with maximum follow-up ranging from 1 to 5 years. Seizure recurrence increased during the follow-up of 1 to 3 years and occurred within 3 years of AED discontinuation. In one study of children with temporal lobe epilepsy, the recurrence rate was 20%. More than 90% of adult patients with seizure recurrence regained seizure control with reinstitution of previous AED therapy. Seizure recurrence was unaffected by the duration of postoperative AED treatment; as a consequence, delaying discontinuation beyond 1 to 2 years of complete postoperative seizure control seems to have no added benefit. The occurrence of rare seizures or auras after surgery did not eliminate the possibility of eventual successful AED discontinuation. CONCLUSIONS: AED discontinuation is associated with a seizure recurrence in one in three patients rendered seizure free by epilepsy surgery. These results will be useful in counseling patients about discontinuing AED treatment after successful epilepsy surgery.     

Multiple sclerosis and epilepsy. An analysis of 14 case histories

Fourteen of 330 patients with the clinical and laboratory supported definite diagnosis of Multiple Sklerose (MS) had epileptic seizures. The epilepsy of six patients probably originates from the MS. Four patients respectively suffered from genuin epilepsy or symptomatic epilepsy caused by other diseases than the MS. Most patients had GM, two GM and focal motor fits and one uncinatus fits. An epileptic focus in the EEG was evident in two patients. MRI- and CCT-scans frequently showed extensive cortex-neighboured lesions and multiple subcortical demyelination, especially localized in the temporal lobe. Epileptic seizures as a symptom of MS are very seldom. The longer the interval from the first episode of the MS to the first epileptic seizure the more probable epilepsy is caused by other reasons than the MS.     

短暂性癫痫性遗忘的临床和电生理研究(附6例报告)

目的探讨短暂性癫痫性遗忘(TEA)的临床和电生理特点。方法对本院脑电监测中心收治的6例TEA患者的临床和电生理特点进行研究。结果 6例患者,女性4例,男性2例,年龄34~74岁。除有癫痫性遗忘发作外,还伴有自动症、部分继发全面强直阵挛发作(s GTCS)、"愣神"等其他癫痫发作形式,5例患者的脑电图均为颞导(单侧或双侧)痫样放电,1例正常。其中5例均给予抗癫痫药物治疗,随访1 y,3例无临床发作,2例偶有发作。结论 TEA常常被误诊或漏诊,尽管大多数颞叶癫痫为难治性癫痫,我们的研究提示伴有TEA的颞叶癫痫对抗癫痫药物反应良好。     

Postictal Courses of Cognitive Deficits in Focal Epilepsies

Summary: Patients with epileptic seizures frequently complain of long-lasting cognitive impairment after a seizure. We evaluated this issue in 31 patients with epileptic seizures of a frontal (n = 8) or temporal lobe origin [right temporal lobe (RTL) n = 8/left temporal lobe (LTL) n = 151. Seizures were secondarily generalized in 18 patients. Computerized testing of verbal and nonverbal recognition memory was performed before the seizure, directly after postictal reorientation, and 30 min and 1 h later. Repeated testing of 14 healthy persons served as control. The following results were obtained: Depending on seizure generalization, postictal reorientation times were 1–45 min. Frontal lobe seizures showed no effect on postictal memory performances, but verbal and visual recognition memory was significantly decreased after temporal lobe seizures. Decrease in either verbal or visual memory and time of recovery were related to lateralization of seizure onset. Functional recovery after reorientation lasted 30 min to 1 h. The decrease in performance was more severe after generalized seizures. Decision times during memory performance were not significantly affected by the seizures. Temporal lobe seizures lead to circumscribed and long-lasting memory deficits, which can be assumed to affect patients'capabilities seriously. Preand postictal testing is a useful tool for determining postictal cognitive impairment and in determining the site of seizure onset.     

Temporal distribution of partial seizures: Comparison of an animal model with human partial epilepsy

Seizures do not often strike randomly but may occur in circadian patterns. We compared daily times of partial seizures determined by continuous electroencephalography among patients with mesial temporal lobe epilepsy (MTLE; n = 64), those with extratemporal lobe (XTLE; n = 26) or lesional temporal lobe epilepsy (LTLE; n = 8), and a rat model similar to MTLE in which rats become epileptic after electrically induced limbic status epilepticus (postlimbic status [PLS]; n = 20). Rats were maintained on a 12-hour light/dark cycle with lights on at 0700 hours. The distributions of seizures were fitted by cosinor analysis to determine time of peak seizure incidence ± 95% confidence interval (95% CI). The mean fraction ± SD of seizures recorded during light was 63 ± 17% in PLS animals and 60 ± 21% in humans. Peak incidence of seizures for PLS rats (547 seizures) was 1645 (95% CI = 1448,1830) and for MTLE subjects (774 seizures) was 1500 (95% CI = 1324,1636). Seizures from XTLE (465 seizures) and LTLE (48 seizures) did not fit a cosinor model and occurred no more frequently during light than dark. In conclusion, limbic seizures in humans and PLS rats occur more often during light than dark and have similar cosinor daily distributions. The chronological similarity between human MTLE and PLS rat epilepsy suggests that limbic seizure occurrence has a relation to the circadian regulatory system.