男性癫痫患者服用抗痫药物后血清甲状腺激素水平及临床意义

目的　研究接受卡马西平 (CBZ)、鲁米那 (PB)和丙戊酸钠 (VPA)单药治疗的成年男性癫疒间 患者的甲状腺激素水平及意义。方法　应用放免法测定 6 3例男性癫疒间 患者 (2 2例服用CBZ ,18例服用PB ,2 3例服用VPA)及 2 0名健康对照者血清中的总甲状腺素 (TT4)、游离甲状腺素 (FT4)、总三碘甲状腺原氨酸 (TT3 )、游离三碘甲状腺原氨酸 (FT3 )和促甲状腺激素 (TSH)水平。结果　CBZ组TT4、FT4和FT3 较对照组明显降低 (均P<0 .0 5 ) ,TT3 和TSH水平无变化 ;PB组的TT4和FT4较对照组明显降低 (均P <0 .0 5 ) ,TT3 、FT3 和TSH水平无变化 ;且PB组的TT4、FT4降低程度均较CBZ组轻 ;VPA组各项指标均无变化。结论　CBZ、PB可通过肝酶诱导等多种途径导致甲状腺激素水平发生改变 ,二者的作用不完全相同 ;VPA对甲状腺功能无影响 ,有必要对服用抗疒间 药物 ,尤其是CBZ患者的甲状腺激素水平进行监测     

男性癫痫病人血清性激素水平的初步观察

用放射免疫法测定５０例成年男性癫痫患者的血清总睾丸酮（ＴＴ）、黄体生成素（ＬＨ）和促卵泡素（ＦＳＨ），并以５０名健康人作对照。结果发现，癫痫组ＴＴ、ＬＨ均较对照组明显升高，频繁癫痫发作、服用苯妥因钠和卡马西平等抗痫药与性激素改变有关。同时对性激素改变的可能机理进行了讨论。对已婚男性癫痫病人有可能或已经发生性功能障碍者，建议选用丙戊酸钠治疗。     

钙调素拮抗剂对癫痫动物模型抗痫作用的研究

目的 了解钙调素拮抗剂有无抗痫作用,为临床上开发新型的抗痫药以进一步控制癫痫提供理论依据。方法 采用记录小鼠脑电图同时观察其行为的方法,观察钙调素桔抗剂W—7对L型钙离子通道激动剂±Bayk—8644致痫小鼠行为和脑电图的影响。结果 钙调素拮抗剂明显延长了痫性发作和痫波发放的潜伏期,减轻了痫性发作程度,减少了痫波发放频率;同时还发现钙调素拮抗剂有一定的镇静作用。结论 钙调素拮抗剂对±Bayk-8644致痫小鼠有抗痫作用。     

癫痫发作后血清催乳素水平改变及其临床意义

发作后15～30分钟血清PRL水平显著升高,这对于鉴别癫痫发作和癔病发作有一定价值.癫痫发作引起PRL异常升高的机理不明.多数认为可能是发作激活了某些特异传导通路,使下丘脑内侧基底部的DA能神经元受到暂时性抑制的结果,并不是非特异的应激反应所致.     

女性癫痫患者血清性激素水平的调查研究

目的了解癫痫发作频率、抗癫痫单药/联合用药治疗及围经期癫痫对女性癫痫患者性激素水平的影响。方法测定入组的87例女性癫痫患者血清泌乳素、雌激素、孕激素、睾酮水平,根据发作频率、单药/联合用药治疗及是否围经期癫痫分组,并比较不同组间性激素的变化。结果高发作频率组泌乳素升高率及发病年龄明显高于低发作频率组和无癫痫发作组;其孕激素下降率高于低发作频率组(P均0.05)。联合用药治疗组睾酮升高率明显高于单药治疗组(P0.05)。围经期癫痫组泌乳素升高率、孕激素下降率及雌/孕比值明显高于非围经期癫痫组(P均0.05)。结论泌乳素升高与近期癫痫发作有关;孕激素下降与癫痫发作严重性有关;抗癫痫药物影响性激素水平,尤以联合应用丙戊酸钠对睾酮作用显著。孕激素、雌/孕比与围经期癫痫密切相关,孕激素补充疗法可能是治疗围经期癫痫的一条有效途径。     

抗痫药物对妊娠及胎儿的影响

随着对癫痫诊治水平的提高,癫痫患者社会适应能力增强.患癫痫的妇女可以结婚、生育,然而她们非常担心孕期服用抗痫药物(AEDs)是否会导致胎儿畸形、是否会将癫痫病遗传给子女及妊娠是否会导致痫性发作加重.事实上,以上担心是有根据的,因为癫痫妇女孕期服用AEDs其婴儿畸变率比未用AEDs治疗者或未患癫痫者高得多[1].用代乳品.     

抗痫药物的致痫作用

目前,癫痫的主要治疗方法是应用抗痫药物(AED_(?)),然而对于部分患者,抗痫药物却不能很好地发挥作用,有时甚至会引起癫痫发作的加重,现就此种情况的特点以及可能的机理作一综述。     

抗癫痫药对男性癫痫患者性激素的影响

用放免法测定２０例服用苯妥英钠（ＤＰＨ），２０例服用卡马西平（ＣＢＺ）的男性癫痫患者的血清性激素水平，包括总睾酮（ＴＴ）、游离睾酮（ＦＴ）和雌二醇（Ｅ２），并与１０例性功能正常男性和２３例未服药的癫痫男性患者对比。结果发现：ＤＰＨ引起ＴＴ和Ｅ２升高，ＣＢＺ则引起下降。说明两种抗癫痫药对性激素的影响机理不同，因而处理也不完全相同。     

抗痫性发作药物联合治疗成人难治性癫痫疗效及安全性的真实世界研究

目的 探讨使用2种及2种以上抗痫性发作药物(ASM)治疗成人难治性癫痫的临床疗效、风险因素和药物不良反应,寻找适合的联合用药治疗方案,以指导多药联合治疗难治性癫痫的临床管理.方法 收集2019年4月至2020年6月在山东大学齐鲁医院神经内科门诊就诊的联合使用2种及2种以上ASM的116例成人难治性癫痫患者门诊资料,记录...     

癫痫患者脑电图痫样放电相关因素及临床意义

目的 分析癫痫患者脑电图痫样放电的相关因素及临床意义。方法 对用２４ｈ便携式磁带记录脑电图（ＩＥＥＧ）检出痫样放电的１６２例癫痫患者进行相关因素分析。结果 在临床表现为全面性发作患者,ＡＥＥＧ可检出有明确定位价值的颅内局灶性异常。睡眠时期痫样放电检出率为８０％,痫样放电主要出现于ＮＲＥＭⅠ－Ⅱ期（７９％）,清醒期及睡眠期均出现痫样放电的７４例患者中其局灶性异常（６７％）均出现于睡眠期,痫样放电仅出     

抗癫痫药物对癫痫患者甲状腺激素水平影响的研究

目的 研究癫痫患者甲状腺激素水平和抗癫痫药物对其影响以及与疗效之间的关系。方法 测定已确诊的45例未服用过抗癫痫药物的癫痫患者血清甲状腺激素水平并与30例健康对照组进行比较。再经卡马西平、苯妥英钠、丙戊酸钠三种抗癫痫药物分组单药治疗3个月、6个月、年后观察甲状腺激素水平的变化及与疗效之间的关系。结果 未服用抗癫痫药物的新诊断癫痫患者游离甲状腺素（FT4）水平显著低于健康对照组,经苯妥英钠、卡马西平分别治疗3个月、6个月、1年后T4、FT4、FT3显著低于治疗前水平,TSH无显著性变化。经丙戊酸钠治疗后的不同时间段各甲状腺激素水平与治疗前比较无显著性差异（P＞0．05）。甲状腺激素水平的变化与化疗效之间似无相关性。结论 癫痫的反复发作虽未经抗癫痫药物治疗已存在FT4水平的降低。苯妥英钠、卡马西平可明显造成癫痫患者的亚临床甲状腺功能降低（T4、FT4、FT3下降）,丙戊酸钠对患者甲状腺激素水平无显著影响。甲状腺激素水平的变化与疗效之间无相关性。     

成年男性癫痫患者血清性腺激素水平的变化

目的： 探讨癫痫发作和ＡＥＤｓ 治疗对垂体一性腺激素平衡的影响。方法： 利用ＲＩＡ法测定了诊断明确的７３ 例成年男性癫痫患者血清ＬＨ、ＦＳＨ、Ｐ、Ｅ２、Ｔ水平, 并比较了ＡＥＤｓ 治疗组与未治疗组和健康对照组病人的血清性腺激素水平。同时,观察了其中的３１ 例癫痫患者癫痫发作前后血清性腺激素水平的变化。结果：癫痫发作前后血清性腺激素水平无明显差异。ＡＥＤｓ 明显影响血清性腺激素水平。在所有ＡＥＤｓ 治疗中, 血清Ｅ２ 水平明显升高, ＬＨ水平明显减低, Ｔ／Ｅ２ 的比较明显低于正常对照和病人对照组, 在ＡＥＤｓ 单一和联合治疗组中有３９．７％ 的病例性功能低下。结论： 癫痫发作不影响血清性腺激素水平。ＡＥＤｓ明显影响性激素平衡和性功能     

Changes in sex steroid levels in women with epilepsy on treatment: Relationship with antiepileptic therapies and seizure frequency

Purpose:   Reproductive dysfunction in epilepsy is attributed to the seizures themselves and also to antiepileptic drugs (AEDs), which affect steroid production, binding, and metabolism. In turn, neuroactive steroids may influence neuronal excitability. A previous study in this cohort of consecutive women with epilepsy showed that patients with more frequent seizures had higher cortisol and lower dehydroepiandrosterone sulfate levels than those with rare or absent seizures. The present study was aimed at evaluating, in these same women, the possible relationship between some clinical parameters, seizure frequency, AED therapies, and sex hormone levels.
Methods:   Estradiol (E2), progesterone (Pg), sex hormone-binding globulin (SHBG), and free estrogen index (FEI) were measured during the luteal phase in 113 consecutive females, 16–47 years old, with different epilepsy syndromes on enzyme-inducing AED (EIAED) and/or non–enzyme-inducing AED (NEIAED) treatments, and in 30 age-matched healthy women. Hormonal data were correlated with clinical parameters (age, epilepsy syndrome, disease onset, and duration), seizure frequency assessed on the basis of a seizure frequency score (SFS), and AED therapies.
Results:   E2, Pg, and FEI were lower, whereas SHBG levels were higher in the epilepsy patients than in the controls. However, sex steroid and SHBG levels were not different between groups of patients categorized according to SFS. Therapies with EIAEDs accounted for changes in E2 levels and FEI.
Conclusions:   Despite globally decreased sex steroid levels in serum, actual hormone titers were not significantly correlated with SFS in consecutive epilepsy women; rather, these hormonal changes were explained by AED treatments, mainly when EIAED polytherapies were given.     

Physical and hormonal profile of male sexual development in epilepsy

PURPOSE: This study was designed to investigate the effect of epilepsy and antiepileptic drugs (AEDs) on both the physical and hormonal aspects of the sexual development of male patients with epilepsy. METHODS: One hundred thirty male subjects with epilepsy, their age ranging between 8 and 18 years (mean, 14 +/- 2.9 years), entered the study; all were taking AEDs. Anthropometric measurements [height, weight, and body mass index (BMI)], testicular volume, penile length, and pubarche were assessed in the studied groups, as well as measurement of the levels of testosterone (T), free testosterone (FT), estradiol (E2), lutenizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin (PRL), and the results were compared with those of a control group. RESULTS: In this study, male patients older than 16 years were significantly shorter than their matched controls. The mean values of testicular volume and penile length were significantly lower in the patients in the different age subgroups, and the pubic hair staging (pubarche) was delayed in the patients older than 16 years. The mean values of total testosterone, estradiol, LH, and FSH serum levels were significantly higher, whereas the mean values of free testosterone, total-T/E2, total. T/LH, and FT/E2 ratios were lower in the patient subgroups compared with their age-matched controls. There were no significant changes in the mean basal PRL serum levels in the patients compared with the controls. The present study demonstrated a reduction in the testicular volume and penile length, significantly lower mean values of free testosterone and total-T/E2, and a higher mean value of E2 in the patients receiving polytherapy in the age subgroup older than 16 years compared with those on monotherapy; however, there was no demonstrable effect of seizure control or the duration of illness in any of the studied parameters. CONCLUSIONS: There is a delay in the sexual development of male patients with epilepsy in the different age subgroups, with endocrine changes in the form of increase in the total testosterone, but the free testosterone is lower, and an increase in estradiol, with lower T/LH levels. Patients receiving polytherapy, especially those older than 16 years, were more likely to have delayed gonadarch and disturbances in their hormonal profile.     

Epilepsy, Sex Hormones, and Antiepileptic Drugs

Summary: Many factors associated with hormone function have an impact on the course of epilepsy. Patients with epilepsy may have disturbances in sexual function such as anovulatory cycles in women and decreased libido and potency in men. Data indicate seizures, especially those arising in the limbic system, may influence the hypothalamic pituitary axis. Antiepileptic drugs also influence sexual function through direct brain effects as well as through induced changes in pharmacokinetics of the sex steroid hormones. Pregnancy has been reported to be a time of increased seizures; however, this has often been associated with low drug levels, for reasons that include inadequate drug dose, possible changes in pharmacokinetics, and noncompliance. Some evidence suggests that hormones affect seizure frequency. Changes in seizures during the menstrual cycle (catamenial epilepsy) have been found in some women: seizures were fewer during the luteal phase but increased when progesterone levels declined. Some improvement in seizure frequency has been shown in pilot studies using medroxyprogesterone acetate, a synthetic progesterone. Current concepts of the interrelationship among epilepsy, sex hormones, and antiepileptic drugs are discussed.     

Current trends in antiepileptic drug therapy

Summary: Over the last two decades, drug therapy for epilepsy has improved substantially. This can be ascribed to a large extent to three factors, including the demonstration of the advantages of monotherapy; the realization of the need for dosage tailoring, coupled [for some antiepileptic drugs (AEDs)] with control of pharmacokinetic variability through therapeutic drug monitoring; and the introduction of newer agents with improved tolerability profiles. What further advances should we expect for the future? Current trends that are expected to increasingly affect our prescribing patterns include greater reliance on evidence‐based medicine and treatment guidelines, a trend that will be facilitated by completion of therapeutically meaningful randomized trials (including cost‐effectiveness studies) and high‐quality observational studies (including multinational pregnancy registries), as well as initiatives from scientific societies and government organizations aimed at condensing the most relevant information into therapeutic guidelines. The explosion in communication technology will accelerate dissemination of this information and its application to clinical practice. Other factors include a more rational patient‐tailored AED selection and dose individualization, aided by characterization of predictors of outcome as defined by clinical parameters (sex, age, epilepsy syndrome, and etiology), pathophysiological mechanisms, and newly discovered genetic markers of outcome; improved definition of the role of new AEDs, resulting in their increased use in newly diagnosed epilepsy; and reappraisal of the value of combination therapy in refractory epilepsies, based on evidence produced by experimental and clinical studies designed to identify favorable pharmacodynamic interactions. Additional important developments may come from the discovery of novel, more efficacious AEDs and from exploration of potential new targets, such as prevention of epileptogenesis.     

Efficacy and tolerability of antiepileptic drugs in an Omani epileptic population

OBJECTIVE: The aim of this hospital-based study is to get an insight into the efficacy and tolerability of antiepileptic drugs (AED) in Omani epileptic patients. PATIENTS AND METHODS: All Omani patients (aged 14 years and above) suffering from epileptic seizures for at least 2 years and followed-up by board-certified neurologists in Sultan Qaboos University Hospital (SQUH) were evaluated. The treatment retention rate since first visit at SQUH and over the last 2 years was used as primary efficacy measure of AED therapy. Change in seizure-frequency and side effect profiles were also assessed. RESULTS: In this population of 203 confirmed epileptic patients, generalized tonic-clonic (40%) and partial seizures (39%) were most commonly observed, idiopathic/cryptogenic origin (81%) being the most frequent encountered origin. Sixty one percent of the patients were controlled with an AED in monotherapy and overall 34% of patients could be successfully maintained on monotherapy during the whole follow-up period at SQUH (median 6 years). The treatment retention rates for carbamazepine (CBZ) at a daily dose of 400-600 mg, sodium valproate (VPA) at a daily dose of 500-1000 mg, and phenytoin (PHT) at a daily dose of 300 mg, in monotherapy over the total follow-up period was 51, 50, and 21%, respectively. In contrast, over the last 2 years these rates were highest for VPA (91%) followed by CBZ (83%) and PHT (73%). Adverse drug reactions were recorded in 67% of patients, and were most commonly encountered with VPA. CONCLUSIONS: Despite a higher adverse effect profile for VPA, long-term treatment with CBZ and VPA appeared to be equally effective in terms of treatment retention rates and seizure control.     

儿童癫痫及抗癫痫治疗对血脂水平影响的研究

对１１４例儿童癫痫患者的血脂水平进行监测。结果发现癫痫本身对血脂水平无影响，抗癫痫药物治疗后总胆固醇和甘油三产高，且随治疗时间的延长差异更为明显，高密度脂蛋白无变化。丙戊酸钠对血脂无影响，而苯舀英钠，苯巴比舀，卡马西平可使ＴＣ，ＴＧ明显升高。     

Seizure frequency and cortisol and dehydroepiandrosterone sulfate (DHEAS) levels in women with epilepsy receiving antiepileptic drug treatment

PURPOSE: Hormonal changes occur in epilepsy because of seizures themselves and of antiepileptic drug (AED) effects on steroid production, binding, and metabolism. Conversely, steroids may influence neuron activity and excitability by acting as neuroactive steroids. This cross-sectional observational study aimed to evaluating cortisol and dehydroepiandrosterone sulfate (DHEAS) levels in female epilepsy patients with different disease severity, as assessed by a seizure frequency score (SFS). METHODS: Morning serum levels of cortisol and DHEAS were assayed in 113 consecutive women, aged 16 to 47 years, with varied epilepsy syndromes, receiving mono- or polytherapy with enzyme-inducing and/or noninducing antiepileptic drugs (AEDs). Hormonal data were correlated with clinical parameters (age, body mass index, epilepsy syndrome, disease onset and duration, SFS, AED therapy, and AED serum levels) and compared with those of 30 age-matched healthy women. RESULTS: In epilepsy patients, cortisol levels and cortisol-to-DHEAS ratios (C/Dr) were significantly higher, whereas DHEAS levels were significantly lower than those in controls. Patients with more frequent seizures showed higher cortisol and C/Dr values and lower DHEAS levels than did those with rarer or absent seizures during the previous 6 months. SFS mainly explained the increase of cortisol levels and C/Dr in patients with more active disease. Changes in DHEAS levels correlated with SFS and epilepsy syndrome, as well as with AED treatments and ages. CONCLUSIONS: Women with more frequent seizures had alterations of their adrenal steroids characterized by an increase of cortisol and a decrease of DHEAS levels. Such hormonal changes might be relevant in seizure control and in patient health.