奥卡西平单药及联合用药治疗部分性癫痫发作23例疗效分析

目的：观察奥卡西平单药及合并其他抗癫痫药物治疗部分性癫痫的临床疗效及安全性。方法：对临床诊断为部分性癫痫的患者共23例（单纯部分性发作3例，复杂部分性发作13例，部分发作继发全身发作7例），采用单药或联合用药治疗，观察治疗前后癫痫发作频率的变化，同时观察用药前后脑电图变化和药物的不良反应。结果：单药治疗组发作频率减少81．09％，总有效率为80．00％；联合用药治疗组发作频率减少82．84％，总有效率为84．61％，用药前后脑电图明显好转者6例，发作严重程度明显减轻，有2例患者用药后有轻度头晕，未见其他明显不良反应。结论：奥卡西平单用及联合其他抗癫痫药物治疗癫痫部分性发作获得满意的临床疗效，且不良反应轻，有较高的临床应用价值。     

维生素E辅助治疗儿童癫痫的临床研究

目的探讨维生素E辅助治疗儿童癫痫的临床应用价值。方法 66例癫痫患儿,分为观察组和对照组,每组33例。对照组给予托吡酯等常规抗癫痫药物治疗,观察组在常规服用抗癫痫药物基础上加用维生素E治疗。检测并比较2组患儿总抗氧化力(T-Aoc)及丙二醛(MDA)水平,比较2组患者治疗效果。结果经足疗程治疗后,观察组治疗总有效率(72.73%)明显高于对照组(48.48%),差异有统计学意义(P<0.05)。治疗后,观察组T-Aoc显著高于对照组,MDA明显低于对照组,差异均有统计学意义(P<0.05)。结论在常规抗癫痫治疗的基础上,应用维生素E辅助治疗,可以有效提升患者体内抗氧化能力,提高治疗有效率。     

Therapeutic drug monitoring (TDM): an aid to anti-epileptic drug (AED) therapy in Zimbabwe: a review

Therapeutic drug monitoring as an aid to maximal anti-epileptic drug therapy in Zimbabwe was reviewed. The rationale behind therapeutic drug monitoring is that the therapeutic response to most anti-epileptic drugs correlates with the concentration in the blood rather than with the dose and that within an optimum therapeutic range, the majority of patients experience maximum benefit with minimum toxicity. This review highlights the fact that therapeutic drug monitoring is required to optimise anti-epileptic drug therapy because it is a predictor of drug compliance; it is ideal for dosage adjustment: it is a good indicator for confirming clinical diagnosis of intoxication and in poly-pharmacy it can be used to identify a culprit compound and in pregnancy and paediatric populations it is ideal for dosage individualization since changes are rapid. TDM of AED is recommended in the 'intractable' seizure group for our setting.     

Fetal drug syndromes

Certain drugs which affect fetal development are considered. Phenytoin taken during pregnancy may result in infants who remain mentally and physically retarded, with abnormal craniofacial appearance and limb defects. A boy with such a syndrome is reported. Trimethadione is another drug which has been said to be teratogenic, and to cause a typical phenotype which is described. The fetal alcohol syndrome is now well recognized and has similar features to those related to anti-epileptic drugs taken during pregnancy. A high level of suspicion of possible associations between congenital defects and drugs must be maintained.     

胸腺肽佐治原发性癫痫患儿临床疗效及免疫功能观察

目的：研究原发性癫痫患儿的免疫功能及胸腺肽佐治的临床疗效。方法：IL－2、SIL－2R及T淋巴细胞亚群测定采用ELISA及APAAP。50例健康儿童为对照组,64例患儿分为二组,采用抗癫痫药物治疗为治疗组1及抗癫痫药物加胸腺肽治疗为治疗组2。结果：治疗组与对照组比较,患儿IgA、CD3、CD4、CD4／CD8及IL－2活性明显降低;而SIL－2R水平明显升高（P均＜0．01）,胸腺肽佐治癫痫患儿的治疗组2与对照组比较,IgA、CD3、CD4、CD4／CD8及IL－2活性明显升高,而SIL－2R水平明显降低（P均＜0．01）且胸腺肽佐治癫痫患儿的治疗有效率85．3％明显高于治疗组1的治疗有效率53．4％（P＜0．01）。结论：癫痫患儿免疫功能缺陷及紊乱,抗癫痫药物对患儿免疫功能没有明显影响,胸腺肽辅助治疗有助于患儿病情康复及免疫功能提高。     

2009～2011年宣武医院抗癫痫药物用药情况监测分析

目的监测癫痫患者抗癫痫药物的用药情况。方法采用荧光偏振法,对来宣武医院就诊的7 292例癫痫患者血清中的抗癫痫药物进行鉴定,并对结果进行分析。结果单纯服用丙戊酸钠或卡马西平的患者分别占总用药人数的32.55%和23.15%;有15.50%的患者服用不明成分的中药制剂。136例患者服用的纯中药制剂,仅占服用中药制剂患者的12%,其余88%的患者服用的中药制剂中均混有抗癫痫药西药成分,其中以苯巴比妥最多,占21.95%;同时混有2种抗癫痫西药成分的占31.33%,混有3种及以上西药成分的占19.64%。另有20.02%患者联合用药。结论通过监测抗癫痫药物用药情况发现,部分癫痫患者未合理使用抗癫痫药物。     

Anti-epileptic drug therapy: an overview of foetal effects

Anti-epileptic drugs are associated with several foetal effects which necessitate a rational use of these drugs and early identification of the various adverse manifestations. This article gives a comprehensive review of foetal adverse effects described with various anti-epileptic drugs. The risk of malformations is increased 2-3 folds compared to general population, especially sodium valproate, more with polytherapy. The various manifestations of foetal anticonvulsant syndrome include developmental delay, malformations like facial clefts and neural tube defects, ocular abnormalities, learning difficulties, and digital hypoplasia. There is less data on effects of new anticonvulsant drugs, but they appear to be safer. The risk of teratogenicity is high with traditional drugs and with polytherapy; the newer agents like lamotrigine and oxcarbazepine are relatively safe. Individualisation of the drug therapy, optimisation of the dose and concurrent folic acid administration are important measures to reduce the potential risk to the foetus.     

抗痫制剂对癫痫模型小鼠学习记忆变化的影响

目的 探讨抗痫制剂对戊四氮致痫小鼠学习、记忆力改变的影响。方法 健康成年雄性小鼠60只,随机分为空白对照组,模型对照组,抗痫制剂大剂量组、中剂量组、小剂量组和丙戊酸钠组,每组10只。抗痫制剂大、中、小剂量组小鼠分别以抗痫制剂 14.8mg/g、7.4mg/g和3.7mg/g灌胃,每天1次,连续7d;复制戊四氮诱导急性癫痫模型;水迷宫测定抗痫制剂对致痫小鼠学习和记忆力的影响。结果 与空白对照组相比,模型对照组小鼠逃避潜伏期延长,行程出错率增加(P<0.05);与模型对照组和丙戊酸钠组相比,抗痫制剂大、中、小剂量组小鼠逃避潜伏期缩短、行程出错率减少(P<0.05)。与模型对照组相比,丙戊酸钠组小鼠逃避潜伏期、行程出错率均值虽增加,但差异无统计学意义(P>0.05)。结论 模型对照组和丙戊酸钠组小鼠学习、记忆力降低;抗痫制剂能缩短模型小鼠水迷宫逃避潜伏期,减少行程出错率,明显改善致痫小鼠学习记忆能力。     

Correlation study on expression of GST-π protein in brain tissue and peripheral blood of epilepsy rats induced by pilocarpine

Previous studies have suggested that glutathione-S-transferase π (GST-π) over-expression in the brain tissue is associated with refractory epilepsy.However,whether the change in GST-π level in the peri...     

儿童期难治性癫痫的治疗进展

如何合理应用抗癫痫药物治疗儿童期难治疗癫痫以获得满意的治疗效果,已经引起广大医务工作者的广泛注意。新型抗癫痫药的问世和应用,给儿童癫痫患者的治疗带来了希望和更多的选择。虽然没有证据显示新型抗癫痫药比传统抗癫痫药更有效,但许多研究已经证明它们的抗痫谱广,药物相互作用和不良反应少,耐受性和安全性较传统抗癫痫药好。神经营养因子、抗氧化剂既有脑保护作用,又有抗癫痫作用。迷走神经刺激术、脑电刺激术、冷却法、放射疗法等物理疗法为难治性癫痫的治疗拓宽新的思路。改良后的生酮饮食疗法的临床实用性值得进一步研究。     

癫痫儿童的心理障碍及干预效果分析

目的研究癫痫儿童的心理状态及干预治疗效果。方法应用癫痫患儿生活质量量表对84例癫痫患儿进行心理评估,并通过癫痫科普知识讲座和个别咨询相结合的方法对本组患儿进行心理干预。结果67%患儿存在心理障碍,主要表现为对发作及药物副作用的担忧,生活满意度低下,情绪及精力差,认知功能及社会能力低下,生活质量低于正常儿童;干预后患儿心理状态明显改善,各项指标前后比较差异显著(P<0.01)。结论癫痫患儿存在心理障碍,抗癫痫药物和心理治疗不能相互替代,只有二者的综合治疗才是有效控制发作、改善患儿心理状态、提高患儿生活质量的根本途径。     

黄疸与药物性肝病回顾性诊断与思考

目的探讨黄疸与药物性肝病的诊断，减少医疗纠纷。方法回顾性总结2004年～2009年我院收治并确诊为药物性黄疸肝病170例患者的临床资料。结果170例病人均有不同程度的肝损害，使用了抗生素、抗真菌药、抗结核药、抗精神病药、抗癫痫药、解热镇痛药、抗肿瘤药、口服降糖药、降血脂药等后，症状明显减轻。结论病人大多预后良好。在药物治疗期间，应严密监视各种毒副反应，视不同的情况进行治疗，只有这样才能提高药物性黄疸肝病的治疗水平。     

Refractory epilepsy: diagnosis and management

Persistence of seizures despite appropriate medical treatment is called refractory epilepsy. Persistent seizures have enormous psychosocial, behavioural and cognitive effects in addition to effects on mortality. Almost 2,40,000 to 3,20,000 patients of refractory epilepsy in India are potential candidates for epilepsy surgery. Causes of refractory or intractable epilepsy are inadequate anti-epileptic treatment, difficulty in treating some epileptic syndromes and difficulty in controlling seizures due to structural brain diseases. Careful evaluation of historical details, especially based on an eyewitness account is the most important aspect in establishing the diagnosis of epilepsy. Raised serum prolactin level helps in differentiating convulsive seizures from non-epileptic convulsions. Video electroencephalographic monitoring is proved effective and efficient mean to establish the rightful diagnosis. Recent developments in neuro-imaging have revolutionised the diagnosis of underlying pathology in patients with refractory epilepsies. Patients with refractory epilepsy should be referred to a specialised epilepsy centre where facilities for epilepsy surgery are available. When medical therapy fails, other options are helpful like use of newer anti-epileptic drugs, vagus nerve stimulation or consideration of epilepsy surgery.     

癫痫发病中突触机制的研究进展

反复的癫痫发作可导致突触蛋白的表达异常、突触重塑和异常神经元网络的形成,这是难治性癫痫的病 理生理学机制之一。近年来发现突触蛋白在原发性癫痫的发病机制中同样发挥重要的作用。多个突触调控蛋白以及 突触后膜受体蛋白表达异常可导致癫痫发作。绝大多数的抗癫痫药物是以离子通道为作用靶点,但卡马西平及唑尼 沙胺可通过影响突触融合蛋白及可溶性N-乙基马来酰亚胺敏感因子附着蛋白受体复合物的功能而发挥抗癫痫作用。 突触囊泡蛋白2A是新型抗癫痫药物左乙拉西坦、布瓦西坦和seletracetam的作用靶点。     

Type I diabetes mellitus in a child presenting with epilepsy partialis continua

Epilepsy partialis continua is an uncommon, localisation-related, seizure characterised by simple partial motor seizures with repetitive clonic jerks. A case of type I diabetes mellitus in a child who had presented with epilepsy partialis continua is presented. Antiglutamic acid decarboxylase 65 antibodies were found in his serum. Seizures were eventually controlled by anti-epileptic drugs, insulin and IV gamma.     

癫痫患儿的生活质量及其影响因素

目的 研究癫痫儿童的生活质量的状况,并分析影响其生活质量的相关因素.方法 应用新的癫病儿童生活质量量表,对83例癫痫儿童进行生活质量的评估,探讨影响因素并与正常儿童进行比较.结果 癫痫儿童的生活质量明显低于正常儿童,尤其是情绪状况、社会功能及认知功能.癫痫患儿的生活质量与疾病的严重程度、长期用药、自我感知及家庭因素等相关.结论 癫痫患儿的生活质量明显低下,综合治疗是提高患儿生活质量的有效途径.     

托吡酯治疗成年癫痫患者的疗效和安全性

目的:观察及评价托吡酯单药治疗成年癫痫患者的疗效和安全性.方法:98例临床新确诊的成年癫痫患者被随机分为2组:一组予以传统抗癫痫药物(卡马西平或丙戊酸钠等)单药系统治疗(AEDs组),另一组予以托吡酯单药治疗(TPM组),即予以托吡酯初始剂量为50mg/d,每3d增加25mg至目标剂量200mg/d.2个月后比较两组的癫痫发作频率和不良反应.结果:TPM组发作次数明显减少,总有效率为79%,完全控制率为33%,不良反应的发生率较低,且症状较轻,患者耐受性良好;AEDs组的总有效率为74%,完全控制率为30%,其不良反应的发生率较高,症状多为中度,需给予对症处理或停药.结论:托吡酯能明显控制癫痫发作,且不良反应轻微,是一种广谱、有效且安全的新型一线抗癫痫药物.     

药物运输泵与难治性癫痫

癫痫患者耐药机制各不相同,其中运输泵机制能限制抗癫痫药物到达癫痫发作部位而引起耐药。运输泵中最典型的是P-糖蛋白(P-glycoprotein,P-gp),主要表达在一些有分泌功能的器官和血脑屏障中,能限制亲脂性药物进入脑内。抗癫痫药物在理论上似乎可以是P-gp的底物,过表达的P-gp降低了这些药物在癫痫灶内的浓度从而引起耐药。这一观点为难治性癫痫的治疗带来了新的希望,如运用一些运输泵的抑制剂来提高脑内抗癫痫药物浓度。     

卡马西平、托吡酯、拉莫三嗪对脑电图影响的研究

目的:探讨抗癫痫药物卡马西平、托吡酯、拉莫三嗪对脑电图的影响。方法:对167例长期口服抗癫痫药物卡马西平、托吡酯、拉莫三嗪的癫痫患儿行进服药前及服药后动态脑电图比较。结果:卡马西平、托吡酯、拉莫三嗪均会使α波变慢,δ、θ波增多,但拉莫三嗪影响较小,卡马西平有会使癫痫波增多的风险。结论:新一代抗癫痫药物对脑电图影响较小,更适合于大脑处于生长发育期的儿童使用。