丙戊酸钠联合左乙拉西坦治疗小儿癫痫临床分析

目的 研究丙戊酸钠结合左乙拉西坦治疗小儿癫痫的有效性及安全性.方法 将2015-06—12我院儿科收治的120例小儿癫痫患儿为研究对象,按照数字随机分组法分成3组,给予不同药物进行治疗,分别为丙戊酸钠组(40例)、左乙拉西坦组(40例)与联合治疗组(40例).观察3组疗效、相关实验室指标与安全性.结果 丙戊酸钠组治疗总有效率77.5%,左乙拉西坦组为72.5%,联合治疗组为92.5%,联合治疗组优于其他2组,差异有统计学意义(χ2=2.37、3.92,P均<0.05);3组治疗前后血钙与血磷水平比较,治疗后联合治疗组血钙与血磷水平均优于其他2组,差异有统计学意义(血钙t=1.14、2.51,血磷t=1.35、1.73,P均<0.05).联合治疗组不良反应率5.0%,优于丙戊酸钠组的12.5%与左乙拉西坦组的15.0%,差异有统计学意义(χ2=1.524、1.473,P<0.05).结论 丙戊酸钠联合左乙拉西坦治疗小儿癫痫的疗效更好,安全性更高,值得临床推广.     

左乙拉西坦治疗不同类型小儿癫痫的临床疗效

目的探析左乙拉西坦治疗不同类型小儿癫痫的临床疗效。方法选择我院2012-03—2015-06收治的81例小儿癫痫患者进行研究,随机分为观察组(n=41)与对照组(n=40)。对照组应用丙戊酸钠治疗,观察组在对照组基础上加用左乙拉西坦,比较2组治疗前后癫痫发作频率、治疗总有效率及不良反应发生率。结果 2组治疗前发作频率组间差异无统计学意义(P0.05),治疗后2组发作频率均降低,组内前后差异有统计学意义(P0.05),同时观察组治疗后的发作频率低于对照组,组间比较差异有统计学意义(P0.05),提示观察组发作频率降低幅度更大。观察组不同类型癫痫患者的治疗总有效率为90.2%(37/41),对照组为72.5%(29/40),观察组明显更高,差异有统计学意义(P0.05)。观察组不良反应发生率为31.7%(13/41),对照组为25.0%(10/40),差异无统计学意义(P0.05)。结论左乙拉西坦在不同类型小儿癫痫临床治疗中的应用可大幅降低发作频率,利于强化治疗效果,且安全可靠,可长期用药,值得推广。     

复方氨基丁酸维E胶囊联合左乙拉西坦治疗小儿癫痫的临床疗效观察

目的分析复方氨基丁酸维E胶囊联合左乙拉西坦对小儿癫痫的治疗效果及安全性,为临床治疗小儿癫痫提供参考。方法选择2010-08—2014-08我院收治的小儿癫痫68例为研究对象,随机分为2组。对照组使用左乙拉西坦治疗,实验组在对照组基础上联合使用复方氨基丁酸维E胶囊治疗,对比观察2组疗效。结果实验组总有效率明显高于对照组,发作频率低于对照组,差异有统计学意义(P0.05)。结论复方氨基丁酸维E联合左乙拉西坦治疗小儿癫痫的效果更好,安全性高,值得应用。     

左乙拉西坦治疗妊娠期癫痫的疗效及对母婴结局的影响

目的 分析左乙拉西坦治疗妊娠期癫痫的临床效果以及对母婴结局的影响。方法 选取河南高等医学专科学校附属医院2018-01―2019-01收治的妊娠期癫痫患者124例作为研究对象,随机分成实验组(左乙拉西坦治疗)和对照组(丙戊酸钠治疗),每组62例,对比2组临床疗效以及妊娠期癫痫发作频率,分析2组产妇妊娠期并发症发作情况,统计胎儿结局和子代喂养情况。结果 实验组总有效率91.94%,对照组为54.84%,组间比较差异有统计学意义(P0.05);实验组发作、单纯发作、复杂发作、全面发作分别为82.26%、8.06%、6.45%、3.23%,对照组分别为56.45%、17.74%、14.52%、11.29%,组间比较差异有统计学意义(P0.05);实验组产妇妊娠期抑郁、妊娠高血压综合征以及围生期癫痫发作发生率分别为11.29%、12.90%、16.13%,对照组分别为29.03%、27.42%、46.77%,组间比较差异有统计学意义(P0.05);实验组新生儿畸形、低体质量儿发生率低于对照组,组间比较差异有统计学意义(P0.05)。结论 左乙拉西坦治疗妊娠期癫痫能够控制患者癫痫发作,降低新生儿异常结局。     

维生素B_6联合左乙拉西坦治疗小儿癫痫的有效性及安全性评价

目的探讨维生素B_6联合左乙拉西坦治疗小儿癫痫的有效性及安全性。方法选取本院收治的110例癫痫患儿作为研究对象,其中60例应用维生素B_6和左乙拉西坦(观察组),50例单用左乙拉西坦(对照组),比较两组患儿的临床疗效及行为异常改善情况。结果与治疗前相比,两组患儿治疗后的癫痫发作频率显著降低,发作持续时间明显缩短(P0.05),并且观察组治疗后的发作频率显著低于对照组,发作持续时间显著短于对照组,(P0.05)。观察组患儿用药期间的行为相关不良反应发生率为6.67%,对照组为32.00%,组间比较有显著性差异(P0.05)。观察组患儿的治疗总有效率为83.33%,显著高于对照组的70.00%(P0.05)。结论大剂量维生素B_6与左乙拉西坦联用能够有效提高小儿癫痫治疗效果,同时减少左乙拉西坦引起的行为异常。     

左乙拉西坦治疗小儿癫痫疗效的Meta分析

目的评价左乙拉西坦治疗小儿癫痫的疗效和安全性。方法计算机检索近十年(2001-2011)来PubMed、Cochrane Database of Systematic Reviews、EMbase、中国知网(CNKI)检索平台、万方数据库中纳入左乙拉西坦治疗小儿癫痫的随机对照研究(RCTs),研究者对文献质量进行严格评价和资料提取。对符合质量标准的RCTs用Review manager 5.0软件进行Meta分析。结果 6个RCTs共610名患者纳入研究,其中治疗组(使用左乙拉西坦)333例,对照组(常规治疗)277例。Meta分析结果表明治疗组患者每周癫痫发病率明显低于对照组,对于患者继发嗜睡、头痛等中枢系统不良反应及肝肾功能损害方面,RCTs结果显示无显著差异。结论左乙拉西坦治疗不良反应种类少,对各种发作类型的小儿癫痫均有良好疗效,且不增加发生其他不良结局的危险性,可作为小儿癫痫患者的首选治疗方案之一。     

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。     

左乙拉西坦治疗成人癫痫的疗效及安全性分析

目的分析左乙拉西坦在成人癫痫患者中的疗效、耐受性及安全性。方法选取我院2013-02—2014-06收治的98例癫痫患者为研究对象,随机分为试验组(LEV治疗)和对照组(常规用药)各49例,疗程40d,观察疗效及不良反应。结果观察组有效率81.6%,对照组为61.2%,2组疗效比较差异有统计学意义(P0.05)。2组指标异常、厌食、嗜睡等不良反应差异无统计学意义(P0.05)。个别患者出现皮疹、白细胞下降症状并不是应用左乙拉西坦造成的。结论左乙拉西坦(LEV)作为一种新型药物,安全性较高,在癫痫治疗的初、中期患者耐受性好,单独使用其治疗效果也十分显著。     

左乙拉西坦对小儿癫痫的疗效及TLR4/NF-kB IL-6 TNF-α hs-CRP水平的影响

目的研究小儿癫痫给予左乙拉西坦治疗的效果及对炎症因子血清白介素6(interleukin-6,IL-6)、血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)及Toll样受体4(TLR4)、核因子(NF-kB)水平的影响作用。方法以商丘市第三人民医院2015-04—2019-04收治的103例小儿癫痫为对象,按照随机数字表法分为2组,对照组51例接受卡马西平治疗,观察组52例患儿接受左乙拉西坦治疗,比较2组治疗总有效率、TLR4/NF-kB水平变化、炎症因子水平变化、认知功能。结果观察组治疗总有效率为94.23%高于对照组的78.43%(P0.05);观察组治疗后TLR4、NF-kB水平均低于对照组(P0.05);观察组治疗后炎症因子IL-6、TNF-α、hs-CRP水平均低于对照组(P0.05)。结论左乙拉西坦治疗小儿癫痫具有良好临床疗效,能够更明显控制TLR4/NF-kB水平,减轻炎症反应,具有良好应用价值。     

左乙拉西坦联合盐酸舍曲林治疗癫痫伴抑郁患儿的疗效观察

目的 探讨左乙拉西坦联合盐酸舍曲林治疗癫痫伴抑郁症儿童的临床疗效。方法 回顾性分析112例6~15岁癫痫伴抑郁症的临床资料,按年龄分为学龄组（6~12岁,56例）和少年组（13~15岁,56例）,评估治疗前后癫痫发作频率、认知功能（WISC-CR）、汉密尔顿抑郁量表17项（HAMD-17）、生活质量、身体质量指数（BMI）、不良反应发生率。结果 与治疗前相比,两组治疗6、12个月,癫痫发作频率、认知功能、HAMD-17评分、生活质量均显著改善（P<0.05）;同时,学龄组癫痫发作频率、认知功能、HAMD-17评分、生活质量均显著优于少年组（P<0.05）;两组治疗后BMI、不良反应发生率无统计学差异（P>0.05）。结论 采用左乙拉西坦联合盐酸舍曲林治疗癫痫伴抑郁症儿童可获得显著的疗效,其中学龄组疗效优于少年组。     

左乙拉西坦治疗低龄难治性癫痫患儿临床研究

目的 探讨左乙拉西坦治疗低龄难治性癫痫患儿的疗效及安全性.方法 纳入我科2008-01-2013-01收治的≤5岁难治性癫痫患儿,随机均分为实验组与对照组,实验组口服左乙拉西坦,对照组口服卡马西平,评价2组患者治疗13周与26周的疗效以及治疗前后的实验室检查结果、不良反应.结果 用药26周后实验组有效率高于对照组、不良反应发生率低于对照组,差异有统计学意义（P＜0.05）,各项实验室检查结果比较差异无统计学意义（P＞0.05）.结论 左乙拉西坦治疗低龄难治性癫痫患儿的疗效显著,安全性好,值得临床推广.     

High‐dose intravenous levetiracetam for acute seizure exacerbation in children with intractable epilepsy

We review our experience with high‐dose intravenous levetiracetam (IV‐LEV) for acute seizure exacerbations in nine children with medically intractable epilepsy. All children had acute repetitive seizures—while on chronic antiepileptic drugs—that either led to hospitalization (eight) or occurred during hospitalization (one), and received doses of IV‐LEV of 150 mg/kg/day or greater, with a mean dose of 228 ± 48 mg/kg/day. Eight of nine children had resolution of the acute repetitive seizures. Seizure frequency was reduced to less than baseline in seven children (seizure‐free in two, ≥80% reduction in four, and 50% reduction in one). Except for one child with increased seizures, IV‐LEV was well tolerated in all children without complications.     

Chronic valproate or levetiracetam treatment does not influence cytokine levels in humans

PurposeThere is growing evidence that complex interactions between seizures and the immune system shape the course of epilepsy. However, systematic analyses of the effects of antiepileptic drugs (AED) on the immune system in humans are rare. We performed a prospective study on the influence of the widely used AED valproate and levetiracetam on interictal immunological parameters.Methods36 patients were prospectively included. 15 were started on valproate (5 female (33%), age 54 ± 27 years, 12 (80%) on monotherapy), 21 on levetiracetam (10 female (48%), age 45 ± 19 years, 17 (81%) on monotherapy). Before treatment and after 3 months, we performed a differential blood count and analyzed the distribution of CD3⁺CD4⁺-, CD3⁺CD8⁺- and CD4⁺CD25⁺-leukocyte subsets using flow cytometry. In addition, we determined the concentrations of IL-1β, IL-6, TNF-α and MCP-1 in the peripheral blood using ELISAs.ResultsValproate intake resulted in a significant decrease of the total white blood count (6.96 ± 1.23/nl vs. 6.13 ± 1.57/nl, p = 0.026) and of absolute count and percentage of neutrophils (4.60 ± 1.05/nl vs. 3.69 ± 1.30/nl, p = 0.01; 65.4 ± 7.9% vs. 59.5 ± 11.5%, p = 0.01, respectively). The percentage of CD3⁺CD4⁺-lymphocytes dropped significantly (50.4 ± 10.9% vs. 45.3 ± 12.3%, p = 0.002). Levetiracetam treatment resulted in a decrease of the percentage of CD4⁺CD25⁺-lymphocytes (26.1 ± 8.0% vs. 21.5 ± 9.2%, p = 0.01) but did not significantly alter absolute counts. Neither valproate nor levetiracetam were associated with significant changes in cytokines.ConclusionValproate intake results in profound changes of white blood cell count and subset distribution. Cytokine levels were not influenced by valproate or levetiracetam.     

Comparison of reproductive effects of levetiracetam and valproate studied in prepubertal porcine ovarian follicular cells

PURPOSE: Long-term valproate (VPA) treatment has been associated with reproductive endocrine disorders characterized by hyperandrogenism and polycystic changes in the ovaries in women with epilepsy. Levetiracetam (LEV) is a promising, new antiepileptic drug that may represent an alternative to VPA for many patients. Here the effect of LEV and VPA on basal and gonadotropin-stimulated steroid secretion from prepubertal porcine ovarian follicular cells was compared and the conversion of testosterone to estradiol is measured. METHODS: Ovarian follicles were obtained from prepubertal pigs. Follicular theca and granulosa cells were cocultured and different concentrations of LEV or VPA added to the control or gonadotropin-stimulated cultures. RESULTS: VPA, but not LEV, caused a significant increase of LH-stimulated testosterone secretion and decreased FSH-stimulated estradiol secretion. VPA decreased conversion of testosterone to estradiol in both basal and FSH-stimulated cultures, while LEV only decreased testosterone to estradiol conversion after FSH stimulation and only at the highest, nontherapeutic drug concentration. Both drugs increased basal testosterone secretion at therapeutic drug levels. VPA also reduced basal estradiol secretion, while LEV decreased basal estradiol secretion only at nontherapeutic drug levels. CONCLUSION: Both LEV and VPA affect endocrine function in the prepubertal ovary. But while VPA alters both basal and gonadotropin-stimulated testosterone and estradiol secretion at therapeutic drug concentrations, LEV only affects basal hormone secretion at this concentration level. The possibility that LEV could be an alternative treatment to VPA if reproductive endocrine problems emerge in adult women, is discussed. However, extrapolation to the clinical situation is problematic and particular emphasis is placed on the need for further studies.     

丙戊酸钠治疗儿童多发性抽动症的疗效分析

目的探讨丙戊酸钠治疗儿童多发性抽动症的疗效。方法将68例多发性抽动症患儿随机分为观察组和对照组,对照组给予氟哌啶醇治疗,观察组给予丙戊酸钠治疗,比较2组治疗总有效率、运动抽动及发声抽动评分及不良反应发生情况。结果 2组总有效比较差异无统计学意义(P>0.05)。观察组治疗后8周后运动抽动及发声抽动评分均优于对照组,差异有统计学意义(P<0.05)。2组不良反应发生情况相当(P>0.05)。结论丙戊酸钠对儿童多发性抽动症的疗效较好,可有效改善患儿运动抽动及发声抽动症状,且不良反应较小,值得临床推广。     

Population pharmacokinetics of levetiracetam and dosing recommendation in children with epilepsy

Purpose:   To develop a population pharmacokinetic model to evaluate the demographic and physiologic determinants of levetiracetam (LEV) pharmacokinetics (PK) and to suggest recommended doses of LEV in children.
Methods:   LEV PK were investigated in a prospective open trial of LEV as adjunctive therapy using a population approach performed with NONMEM (Nonlinear Mixed Effects Model) on 170 LEV concentration–time records and covariate information from 44 children between 4 and 16 years of age. Possible associations between pharmacokinetic parameters and age, gender, body weight, creatinine clearance, and concomitant antiepileptic drugs (AEDs) were assessed. The final model was used to perform Monte Carlo simulations in order to identify the dosing regimens that should achieve the same nominal target concentration range as in adults.
Results:   LEV PK were well described by a one-compartment model with first-order absorption and elimination. Both LEV apparent clearance and distribution volume were related to body weight, and no pharmacokinetic interaction was observed. Monte Carlo simulations showed that a 10mg/kg twice daily (b.i.d.) regimen provides a plasma concentration similar to that obtained in adults for the recommended 500 mg b.i.d. starting dose, and that a 20 mg/kg b.i.d. regimen would achieve the previously described 6–20 mg/L target range for the trough concentration.
Discussion:   Our results support the use of a weight-based LEV dosing regimen and provide a basis for a recommended pediatric dosage regimen. The relationship between LEV plasma concentrations and clinical effect has not been evaluated fully and could differ between adults and children. Clinical studies should be able to validate these dosing recommendations.