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.     

丙戊酸钠与左乙拉西坦治疗小儿癫痫的临床疗效分析

目的分析丙戊酸钠与左乙拉西坦治疗小儿癫痫的效果。方法选取我院治疗的小儿癫痫患者80例为研究对象,采用数字随机表将患儿分为对照组和观察组,对照组取丙戊酸治疗,观察组取左乙拉西坦治疗,观察2组血清神经元特异性烯醇化酶(NSE)、S100β及癫痫发作频率变化情况,观察临床疗效和不良反应发生情况。结果观察组治疗后NSE、S100β水平分别为(12.10±2.07)μg/L、(0.48±0.16)μg/L均显著低于对照组(20.31±3.11)μg/L、(0.68±0.23)μg/L,差异具有统计学意义(P0.05)。观察组治疗后简单部分发作、肌阵挛发作、强直阵挛发作、复杂部分性发作频率分别为(8.64±2.58)次、(9.21±1.05)次、(5.31±1.06)次、(5.98±0.87)次显著低于对照组,差异具有统计学意义(P0.05)。结论丙戊酸钠和左乙拉西坦可取得同等的抗癫痫效果,但左乙拉西坦具有神经保护的作用。     

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。     

左乙拉西坦联合穴位埋线治疗小儿癫痫的疗效对比

目的观察左乙拉西坦联合穴位埋线法治疗小儿癫痫的临床疗效。方法将我院2014-01-2016-01收治100例癫痫患儿随机分为治疗组和对照组,其中治疗组50例采取左乙拉西坦片联合穴位埋线法治疗,对照组50例采取单药左乙拉西坦片治疗,连续观察3个月,检测2组治疗前后血清中NSE及IGF-1变化,对比2组临床疗效。结果治疗3个月后治疗组NSE及IGF-1水平分别为(11.91±2.13)μg/L、(7.45±2.54)μmol/L,均显著低于对照组(19.64±3.05)μg/L、(10.21±3.17)μmol/L,差异具有统计学意义(P0.05),治疗组总有效率为92.0%,对照组为74.0%,差异有统计学意义(P0.05),且治疗过程中2组患儿均未出现明显的不良反应发生。结论左乙拉西坦联合穴位埋线治疗小儿癫痫疗效优于单纯左乙拉西坦治疗,且无明显不良反应,值得临术推广应用。     

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。     

探讨常用抗癫痫药物对小儿癫痫血同型半胱胺酸水平的影响

目的探讨常用抗癫痫药物对小儿癫痫血同型半胱胺酸水平的影响,从而最大限度的降低治疗风险。方法我院2010-08—2015-08 5a间共收治小儿癫痫患者120例,随机将其分为卡马西平组、丙戊酸钠组苯巴比妥治疗组,3组分别由40例小儿癫痫患者组成,对比3组患者治疗前后血同型半胱胺酸水平。结果治疗前,卡马西平组、丙戊酸钠组合苯巴比妥治疗组患者的血同型半胱胺酸平均水平分别为(6.65±3.05)mmol/L、(6.52±3.02)mmol/L和(6.69±3.07)mmol/L,治疗6个月后,3组患者的血同型半胱胺酸水平与治疗前相比差异无统计学意义(P0.05);治疗1a后,3组患者的血同型半胱胺酸水平与治疗前相比差异有统计学意义(P0.05)。结论对于常用抗癫痫药物马卡西平、丙戊酸钠和苯巴比妥而言,三种药物均会导致小儿癫痫患者血同型半胱胺酸水平增高,特别是在治疗1a后,需引起注意。     

左乙拉西坦联合丙戊酸钠治疗全面性癫痫持续状态的疗效及对CKMB水平的影响

目的观察左乙拉西坦联合丙戊酸钠治疗全面性癫痫持续状态的疗效及对CKMB水平的影响。方法选取我院收治的90例全面性癫痫持续状态患者,采取随机数字表法分为单独用药组与联合用药组各45例,单独用药组仅给予丙戊酸钠治疗,联合用药组在其基础上加用左乙拉西坦治疗,比较2组临床疗效、起效时间、控制时间、苏醒时间及发作前、发作6h后的CKMB水平。结果单独用药组总有效率为55.56%,联合用药组的总有效率为93.33%,联合用药组的总有效率明显高于单独用药组(P0.05)。联合用药组较单独用药组相比起效时间、控制时间、苏醒时间均明显缩短(P0.05)。2组发作2h内与发作前血清CKMB均明显升高(P0.05)。发作后6h与发作2h内相比明显降低,且联合用药组降低更加显著(P0.05)。结论癫痫患者发生癫痫期间可伴有CKMB水平升高,可加强对CKMB检查,采用左乙拉西坦联合丙戊酸钠治疗可获得显著疗效,缓解临床症状,对心肌损伤较少,值得推广。     

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。     

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。     

托吡酯及丙戊酸钠对癫痫患儿血清六种常微量元素的影响

目的观察托吡酯及丙戊酸钠对癫痫患儿血清六种常微量元素的影响。方法选取80例癫痫患儿,40例予托吡酯(TPM)单药治疗,40例予丙戊酸钠(VPA)单药治疗,选取40例健康儿童作正常对照。所有儿童于治疗前及治疗6个月后行锌、铁、铜、钙、镁及铅检测。结果癫痫患儿治疗前血清钙、铁及锌分别为(1.45±0.40)mmol/L、(7.25±2.16)mmol/L、(69.88±10.99)μmol/L,明显低于对照组[分别为(1.66±0.45)mmol/L、(8.26±2.65)mmol/L、(78.24±12.44)μmol/L],差异有统计学意义(P0.05),铜、镁及铅含量与对照组比较,差异无统计学意义(P0.05)。VPA组与TPM组治疗前铜、锌、镁、钙、铁及铅含量比较,差异无统计学意义(P0.05)。2组治疗后各种元素含量比较,差异无统计学意义(P0.05)。癫痫患儿治疗前后各种元素含量比较,差异无统计学意义(P0.05)。结论癫痫患儿血清锌、钙及铁含量降低。VPA及TPM治疗对癫痫患儿血清锌、铁、铜、钙、镁、铅含量无明显影响。     

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。     

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。     

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.     

Levetiracetam may worsen myoclonus in patients with juvenile myoclonic epilepsy: case reports

Levetiracetam was approved for generalized and partial epilepsy in pediatric and adult population. It is also an effective antimyoclonus, but the evidence only supports its use as an adjunctive agent along with other antiepileptic drugs, such as sodium valproate, and it is commonly used in cases with juvenile myoclonic epilepsy. We report here 2 cases with juvenile myoclonic epilepsy who were switched from sodium valproate to levetiracetam to avoid the cosmetic or future teratogenic effect, but this switch was associated with exaggerated myoclonus despite escalating the dose of levetiracetam but resolved completely after reintroducing sodium valproate.     

Effects of Sodium Valproate Combined with Lamotrigine on Quality of Life and Serum Inflammatory Factors in Patients with Poststroke Secondary Epilepsy

BackgroundWe sought to explore the effects of sodium valproate combined with lamotrigine on quality of life and serum inflammatory factors in patients with poststroke secondary epilepsy.MethodsA total of 145 patients with post-stroke secondary epilepsy admitted to our hospital from January 2017 to June 2018 were collected: 76 treated with sodium valproate combined with lamotrigine (study group) and 69 patients treated with sodium valproate alone (control group). The levels of serum high-mobility group protein B1, matrix metalloproteinase 9, and interleukin 6 were detected before and after treatment, and the therapeutic efficacy and adverse reactions were compared between the 2 groups.ResultsThe total effective rate of the study group was higher than that of the control group. Both groups decreased in epileptiform discharges or in the number of involved leads after treatment, with the results of the study group being lower than those of the control group. The quality of life scores in both groups was increased after treatment, albeit the scores of the study group were higher than those of the control group. In terms of the levels of serum inflammatory factors, the 2 groups were reduced after treatment; the levels of the study group were lower than those of the control group. Regarding the incidence of adverse reactions, no significant difference was seen between the 2 groups.ConclusionsSodium valproate combined with lamotrigine has better clinical efficacy and higher safety in the treatment of poststroke secondary epilepsy and is able to reduce the expression levels of serum inflammatory factors.     

Effects of valproic acid and levetiracetam monotherapy on carotid intima-media and epicardial adipose tissue thickness in non-obese children with epilepsy

ObjectiveThe aim of the study was to investigate the risk of subclinical atherosclerosis independent from obesity and high blood lipid levels in pediatric patients with idiopathic epilepsy receiving valproic acid or levetiracetam monotherapy by evaluating carotid intima-media thickness (CIMT) and Epicardial adipose tissue thickness (EATT).MethodsA total of 75 patients (38 males, 37 females; mean age 127.2 ± 37.9 months) with epilepsy receiving either valproic acid or levetiracetam monotherapy for more than 12 months (Epilepsy Group) and 75 sex, age, body mass index (BMI) matched healthy children (40 males, 35 females; mean age 133.8 ± 38.7 months) (Control Group) were included in the study. The mean duration of therapy was 27.6 ± 10.5 months. Serum lipid levels (total cholesterol, triglycerides, low density lipoprotein, high density lipoprotein) and CIMT-EATT of the patients and controls were assessed. Also, epilepsy group were divided according to antiepileptic drugs (valproic acid group and levetiracetam group).ResultsThe CIMT was determined as 0.6 ± 0.08 mm in epilepsy group and 0.49 ± 0.15 mm in control group (p < 0.001). The EATT was measured as 5.96 ± 0.8 mm in epilepsy group and 3.7 ± 0.5 mm in control group (p < 0.001). Of epileptic patients, 45 were using valproic acid monotherapy and 30 were on levetiracetam monotherapy. There was no significant difference in terms of CIMT between valproic acid and levetiracetam groups (0.61 ± 0.09 mm vs. 0.57 ± 0.07 mm; p = 0.07). EATT measurements were significantly higher in valproic acid group compared to levetiracetam group (6.14 ± 0.8 mm vs. 5.7 ± 0.7 mm; p = 0.02). CIMT and EATT values were not associated with the dosage and duration of each antiepileptic drug.ConclusionNon-obese children with epilepsy receiving valproic acid or levetiracetam monotherapy might have an increased risk for developing subclinical atherosclerosis despite normal lipid levels. The effect of valproic acid was more evident especially on EATT.     

抗癫痫药物应用专家共识

目的 编制我国抗癫痫药物应用专家共识.方法 采用无记名问卷调查形式,收集我国三级医院中成人神经科专科医生有关抗癫痫药物的应用经验与评价.调查内容为特发性全面性癫痫与症状性部分性癫痫的药物治疗,以及特殊人群与伴有共患病患者的抗癫痫药物应用.药物评价标准采用九级分级制.药物治疗策略评价根据专家评分所得均数、标准差与95%可信区间(95%CI),分为首选药物、一线、二线与三线药物.结果 发出问卷50份,回收49份(98%).49名专家中,男性38名(77.6%),女性11名(22.4%),年龄(53.9±10.8)岁(35～81岁),平均从业时间(17.9±10.2)年(3～45年),所有专家每月诊治癫痫患者20～800例(中位数100例).总体治疗策略中,有关特发性全面性癫痫与症状性部分性癫痫的首选治疗,100%的专家选择单药.丙戊酸是新诊断特发性全面性癫痫的一线药物且惟一的首选药物.症状性部分性癫痫的初始药物首选均为卡马西平和奥卡西平.在特发性全面性癫痫药物治疗中,丙戊酸是与其他药物联合治疗的首选药物.症状性部分性癫痫的药物治疗中,卡马西平(奥卡西平)+托吡酯、卡马西平(奥卡西平)+左乙拉西坦、卡马西平(奥卡西平)+丙戊酸、丙戊酸+拉莫三嗪等是常用配伍.拉莫三嗪为健康育龄期妇女特发性全面性癫痫与症状性部分性癫痫的首选用药;伴抑郁的癫痫患者,特发性全面性发作的首选用药为丙戊酸与拉莫三嗪,继发性部分性发作的首选用药为拉莫三嗪、奥卡西平与卡马西平;伴有乙肝的癫痫患者,无论肝功能是否正常,特发性全面性发作的首选用药为托吡酯与左乙拉西坦,肝功能正常的继发性部分性患者,首选用药为奥卡西平,肝功能指标异常时,首选用药为托吡酯与左乙拉西坦;急诊室中的癫痫患者(不确定类型)首选丙戊酸与左乙拉西坦.结论 本共识归纳专家的临床经验,将对癫痫的药物治疗有帮助.

Abstract：

Objective To prepare expert consensus opinion in treatment of epilepsy in China.Methods To sent an anonymous questionnaire on the treatment of adolescent and adult epilepsy syndromes to a group of hospital neurologists in the field of epilepsy. The questions were formatted to simulate real-world clinical situations in the treatment of symptomatic localization related epilepsy (SLRE), idiopathic generalized epilepsy (IGE), and treatment in special patient populations and patients with comorbidity. The experts were asked to rate treatment options based on a modified RAND 9-point scale (with "9" most appropriate and "1" least appropriate). Statistical analysis of data was performed as defined by the expert consensus method. The results were used to develop user-friendly recommendations concerning overall treatment strategies and choice of specific medications. Results Of the 50 experts to whom the survey was sent, 49 (98%) responded. Of the respondents, 11 (22.4%) were female and 38 (77.6%) male. Their mean age was 53.9 years, with a mean of 17.9 years in practice. The median number of patients seen per month was 100 ( range, 20 to 800 ). For initial monotherapy of IGE ( generalized tonic-clonic ( GTC ),absence, and myoclonic seizures), valproate was rated as treatment of choice. Treatment options were rated for 3 types of SLRE: simple partial seizures ( SPS), complex partial seizures ( CPS ) , and secondarily generalized tonic-clonic seizures (SGTC). In SLRE-SPS and SLRE-CPS, carbamazepine and oxcarbazepine were treatments of choice, with lamotrigine, topiramate and levetiracetam as second line agents. In SLRESGTC, carbamazepine, lamotrigine and oxcarbazepine were treatments of choice, while lamotrigine,topiramate, levetiracetam and valproate were also usually appropriate. Valproate was selected as treatment of choice when combined with other AEDs in IGE. For SLRE, combination/add-on therapy of carbamazepine ( oxcarbazcpine ) + topiramate, carbamazepine ( oxcarbazepine ) + levetiracetam, carbamazepine (oxcarbazepine) +valproate, valproate + lamotrigine were considered as treatment of choice. For women who are pregnant or trying to conceive, lamotrigine was treatment of choice for both idiopathic generalized epilepsy (IGE) and symptomatic localization related epilepsy (SLRE). For patients with school-age,lamotrigine was treatment of choice for IGE, with oxcarbazepine and lamotrigine for SLRE. In people with both epilepsy syndromes who have depression, valproate and lamotrigine were treatment of choice for IGE; in SIRE, lamotrigine, oxcarbazepine and carbamazepine were treatment of choice. In persons with epilepsy and hepatitis B, whether liver function was normal or not, topiramate and levetiracetam were treatment of choice for IGE; in SLRE with normal liver function, oxcarbazepine was treatment of choice, while topiramate and levetiracetam were selected for SLRE with liver function impairment. Valproate and levetiracetam were treatment of choice for seizures in the emergency department. Conclusions The expert consensus method concisely summarizes expert opinion, and this opinion may be helpful in situations in which the medical literature is scant or lacking.     

抗癫癎药物对儿童临床下癎性电持续状态及认知功能的影响

目的：探讨抗癫?药物（AED）对临床发作已控制,但脑电图（EEG）上仍存在癫?性电持续状态ESES患者的认知功能的影响。方法：收集2013年3月～2015年11月本院门诊、住院治疗的儿童癫?患者,用日本光电9000型长程录像脑电图（V‐EEG）监测到的16例临床下ESES患者,临床无发作均超过半年,随访观察,调整治疗方案前后均再进行神经心理学评估和V‐EEG监测。结果：16例应用卡马西平（CBZ）、奥卡西平（OXC）临床发作均已得到控制,V‐EEG提示仍存在ESES现象,神经心理学评估均存在不同程度的认知功能障碍,治疗方案调整为丙戊酸钠／丙戊酸镁、左乙拉西坦／托吡酯,3个月后复查V‐EEG提示ESES消失,脑功能状态得到改善（P＜0．05）。结论：AED的治疗目的,不仅要控制临床发作,也要控制临床下?样放电,特别是ESES现象。     

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。