托吡酯治疗卡马西平耐药性癫(癎)33例的疗效观察

我科从2002年10月-2004年2月对卡马西平（CBZ）耐药的33例癫痫患者加用托吡酯（TPM）治疗，取得显著疗效，现报告如下。 1对象与方法 1．1对象男19例，女14例；年龄13—65岁，平均29．6岁：病程3～6年，平均4．5年。     

河南省农村地区癫痫防治管理项目效果分析

目的对河南省召陵区农村地区癫痫防治管理项目效果进行分析。方法对部分农村符合标准的惊厥性癫痫患者采取一定措施进行管理、随访,并用苯巴比妥进行规范化免费治疗,分析治疗管理率、退出治疗原因、治疗剂量及治疗效果。结果管理率为52.60%,退组45例,死亡4例,服药剂量以90 mg/d及120 mg/d为主,治疗显效66.01%,有效26.12%。结论农村地区癫痫防治管理项目的实施,提高了各级级卫生人员癫痫防治水平,使癫痫病患者得到规范化治疗,减轻患者的痛苦与经济负担。     

我国农村地区607例癫痫患者应用丙戊酸钠治疗效果评价

目的 观察基层医生使用国产丙戊酸钠(VPA)治疗癫痫的可行性、疗效及其不良反应.方法 癫痫患者来自湖北省天门市和广西田东县农村地区.由县、乡级医生按规定的入选标准筛选病例,并使用VPA治疗和随访.疗效评估以发作频率与治疗前的变化为标准,其中无发作、显效和有效三者之和为总有效率.结果 入组607例癫痫患者接受治疗随访,男性395例,女性212例,其中579例随访满12个月.患者中全面强直-阵挛性发作517例(85.2%),失神发作20例(3.3%),其余70例(11.5%)为部分性发作、单纯强直、阵挛、肌阵挛或失张力发作.服药满3个月、6个月、12个月时癫痫发作完全控制的患者分别有270例(45.5%)、249例(42.3%)和238例(41.1%),总有效率三个时段分别为65.2%、75.4%和85.5%.治疗随访期间共有58例出现困倦、嗜睡、疲乏、头晕等不良反应.治疗随访期间有19例(3.1%)先后脱组.结论 VPA是一种疗效较好、严重不良反应少、基层医生比较容易掌握的广谱抗癫痫药,同苯巴比妥一样适合在我国农村地区推广应用.

Abstract：

Objective To observe the efficacy and the side-effects of sodium valproate (VPA) in patients with epilepsy in rural China. Methods Epilepsy patients were selected from rural areas of Tianmen in Hubei province and Tiandong county in Guangxi province according to the inclusion and exclusion criteria.Efficacy evaluation standard depending on the change of seizure frequency compared with the situation prior to entering the treatment group. Among the treated patients, no seizures, seizure reduced ＞ 75%, seizure reduced 50%-75% sums for the total effective rate. Results All 607 patients with epilepsy were treated and followed up, the male were 395 (65. 1% ) female 212 (34. 9% ), and 579 patients were treated for 12 months. Patients with generalized tonic-clonic seizures were 517 (85.2%), absence seizures 20 (3. 3% )and the other types of seizures 70 (11.5% ) including simple partial seizures, tonic, clonic, myoclonic or atonic seizures etc. The completed control of seizures ( without any seizures) during the period after taking 3 months, 6 months, 12 months were 270 (45.5%), 249 (42. 3% ) and 238 (41.1%) respectively. The total effective rates in the three periods were 65.2% , 75.4% and 85.5% respectively. The 58 patients in the total group showed side-effects during the follow-up period, mainly including drowsiness, lethargy,fatigue, dizziness, headache and tremor. Nineteen patients (3. 1% ) quitted the treatment group.Conclusions The VPA is an effective antiepileptic drug and no more severe side-effects. It is the same as Phenobarbital and suitable to be used in rural areas of China.     

绵阳市规范管理的精神分裂症患者治疗效果的回顾性分析(英文)

背景 在过去的6年里,中国开展了世界上最大规模的重性精神病社区管理治疗项目(简称686项目),但项目实施的效果并未得到详细的评估。目的 对参与该项目的精神分裂症患者的临床有效者与临床无效者的特征进行比较。方法 从该项目的全国登记系统电子数据库中,提取2011年在四川省绵阳市(农村人口占60%)参加该项目的精神分裂症患者的资料,共3090份。根据精神科医生2011年的末次评估,将患者的疗效为"治愈"或"好转"者归为有效组(n=1866),将"无变化"或"加重"者归为无效组(n=1224),比较两组之间的社会人口学特征和治疗特点。收集的资料包括性别、年龄、民族、职业、文化程度、家庭经济状况、婚姻状况、精神疾病家族史、患病时间、参加686项目的时间以及治疗依从性等。结果 单因素分析结果显示,除性别、民族和精神疾病家族史外,其他因素的组间差异均有统计学意义。年龄小、病程短、受教育时间长、家庭经济状况好、治疗依从性好、参与686项目时间短的患者疗效更好。Logistic回归分析结果显示,服药依从性差、家庭贫困以及参加686项目时间长等因素更多见于疗效"无变化"或"加重"的患者。结论 治疗依从性差和家庭贫困严重地影响了686项目的效果。想方设法提高精神疾病患者的治疗依从性,向患者家庭提供基本的经济支持,将有助于提高该项目的成效。     

A preliminary observation of the adverse effects of phenobarbital among patients with convulsive epilepsy in rural West China

BackgroundThis study explored the adverse effect (AE) profile of phenobarbital (PB) among patients with active convulsive epilepsy (ACE) from resource-poor areas.MethodsPatients with ACE were enrolled into an epilepsy management project in rural West China. Information was obtained from monthly follow-up questionnaires. The demographic and clinical features of the patients with AE were firstly described. After that, the occurrence rate was estimated for each subtype of AE at three different severity levels (mild, moderate, and serious). Survival analysis was used to determine the potential risk factors of AEs.ResultsA total of 7231 patients (3780 men) were included in the present cohort. During the follow-up time period (average 33.4 months), the most common AEs were drowsiness (moderate: 4.4%, serious: 0.68%), dizziness (moderate: 3.7%, serious: 0.5%), and headache (moderate: 2.9%, serious: 0.41%). In the confirmed AE groups (moderate and serious severity levels), the symptoms tended to be transient, with durations of less than 3 months. Polytherapy was an independent risk factor for AEs and had an increasing risk when the severity of the AE increased (Hazard Ratio 1.12, 1.55, and 2.52 for mild AE, moderate AE, and serious AE, respectively). Receiving a high dosage of PB (> 180 mg/day) indicated a slightly elevated risk (Hazard Ratio 1.22 and 1.27 for mild AE and moderate AE, respectively).ConclusionPhenobarbital demonstrates overall tolerability, and serious AEs were not common. Patients receiving a high dose of PB or polytherapy are at increased risk of developing AEs.     

癫患者心理治疗临床观察

目的 观察癫癎患者心理干预的效果.方法 应用格瑞思<症状自评量表SCL-90>,对317例癫癎患者的心理状态进行评估,在抗癫癎药物治疗的同时,以多种心理咨询方式对患者进行心理干预.结果 317例患者经心理干预后,干预组治疗前后疗效显著(P<0.01),对照组前后比较差别无统计学意义(P＞0.05),干预组追踪测试结果 与治疗后相比无明显差别,干预效果比较稳定(P＞0.05).结论 多数患者因心理障碍影响生活质量.心理干预是消除或减轻患者心理障碍的有效治疗方法 ,应成为癫癎综合治疗不可缺少的组成部分.     

Efficacy assessment of phenobarbital in epilepsy: a large community-based intervention trial in rural China

BACKGROUND: Many people with epilepsy need not experience further seizures if the diagnosis and treatment are correct. Most epilepsy patients have convulsions, which are usually fairly easy to diagnose. This study tested a model for treatment of people with convulsive forms of epilepsy at primary health-care level in rural areas of China. METHODS: Patients with convulsive epilepsy were identified at primary care level and provided with phenobarbital monotherapy. Local physicians, who were provided with special training, carried out screening, treatment, and follow-up. A local neurologist confirmed the diagnoses. Efficacy was assessed from the percentage reduction in seizure frequency from baseline and the retention of patients on treatment. FINDINGS: The study enrolled 2455 patients. In 68% of patients who completed 12 months' treatment, seizure frequency was decreased by at least 50%, and a third of patients were seizure free. 72% of patients who completed 24 months' treatment had reduction of seizure frequency of at least 50% and a quarter of patients remained seizure free. Probability of retention was 0.84 at 1 year, and 0.76 at 2 years. Medication was well tolerated and reported adverse events were mild; only 32 patients (1%) discontinued medication because of side-effects. INTERPRETATION: This pragmatic study confirmed that this simple protocol was suitable for the treatment of convulsive forms of epilepsy in rural areas of China. Physicians with basic training could treat epilepsy patients with phenobarbital, with beneficial effects for most patients with convulsive seizures. Few cognitive or behavioural adverse events were noted, but formal psychometric testing was not done.     

我国五省农村地区开展人群干预后癫(癎)治疗缺口的变化

目的 检验我国农村地区开展人群干预管理后癫癎治疗缺口的变化，为进一步推广癫癎社区控制经验提供依据。方法 2004年WHO合作项目结束后6个月，在开展项目的5个省农村示范地区，采用与基线调查完全相同的方法和标准随机抽样调查该地区癫癎流行病学状况，并对两次调查结果进行比较，以了解示范区干预前后癫癎患者的治疗情况以及治疗缺口的改变。结果 本次抽样调查5个农村人群共确诊癫癎患者320例，患病率为0．62％。其中活动性癫癎的患病率为0．45％。而基线调查时癫癎患病率和活动性癫癎的患病率分别为0．70％和0．46％。采用正规治疗的癫癎患者由2000年调查时的24．8％上升至39．1％。活动性癫癎的治疗缺口由基线调查时的62．6％下降为49．8％。结论 农村地区的癫癎患者经过WHO示范项目的干预和管理，接受正规或合理治疗的比例明显提高；活动性癫癎的治疗缺口显著下降。从而证明本方案采用的干预对策适用于我国农村地区，并有很好的推广价值。     

Efficacy and safety evaluation of loreclezole as add-on treatment in therapy-resistant epilepsy patients

Thirteen drug-resistant epilepsy patients received loreclezole as add-on therapy. The trial lasted 6 months. Loreclezole was dosed to reach a target plasma concentration between 1 and 3 mg/l. The seizure frequency in the total group decreased by 23%. A reduction of 50% or more was observed in four patients. These effects are most likely related to loreclezole, as doses and plasma levels of the associated anti-epileptic drugs remained unchanged during the study. Loreclezole was tolerated well and no changes in haematological or biochemical parameters were observed.     

奥卡西平治疗癫癎的临床观察

目的观察奥卡西平(OXC)治疗癫疒间部分性发作/继发全面性强直-阵挛发作(PS/SGTCS)或特发性全面性强直-阵挛发作(GTCS)的疗效、耐受性和安全性。方法61例PS/SGTCS或GTCS患者,其中40例新诊断癫疒间和未经正规治疗的患者进入OXC单治组;而21例长期先后应用过多种抗癫疒间药治疗者进入OXC加治组。成人OXC起始量均为150 mg每晚1次,维持剂量(600~2 400)mg/d,分2次服用;儿童起始量(4~5)mg/kg每晚1次,维持剂量(30~40)mg/(kg.d)。进行自身对比开放性观察,同时分析单治组与加治组24周内的疗效、不良反应、耐受性和安全性。结果本组总有效率和显效率分别为62.3%和54.1%,控制率为49.2%,累积退出率为24.6%,3例(4.9%)失访,因不良反应和经济原因退出12例(19.7%),其中2例(3.3%)因皮疹退出。最常见的不良反应:乏力6例;头昏、头痛、嗜睡各5例;恶心、皮疹各2例。结论OXC治疗PS/SGTCS或GTCS的疗效明显,不良反应轻,耐受性好,安全性高。     

中国农村黑龙江省东宁县癫痫的流行病学研究

目的：提供客观、可信的中国农村人群癫痫的流行病学资料。方法：应用世界卫生组织建议的癫痫流行病学调查表，采用随机整群抽样方法，对东宁县内4镇6乡全体居民进行面对面的流行病学普查，应查人口10823人，实查人口10151人，见面率93．8％。结果：癫痫的患病率为7．98／1000；癫痫的年发病率为29．55／10万；超过50％的患者首次发病年龄在20岁之内；特发性癫痫占79．01％，中枢神经系统感染性疾病是症状性癫痫的主因；最常见的发作类型为全身强直－阵挛发作。结论：东北农村癫痫的患病率与发达国家情况相似。     

Current status of epilepsy treatment and efficacy of standard phenobarbital therapy in rural areas of Northern China

Purpose: To investigate the current status of epilepsy treatment and the efficacy and adverse effects of phenobarbital therapy in rural areas of Northern China. Methods: A total of 2192 patients diagnosed with convulsive epilepsy were recruited from seven different rural regions in Jilin Province, China to investigate the current status of epilepsy treatment, and 1379 of them were enrolled in a standard phenobarbital therapy trial. Patients were selected according to strict inclusion and exclusion criteria, and medical records for all patients were collected and analyzed before the standard treatment was started. Patients were followed up monthly, and efficacy in 1218 patients was analyzed at 1, 3, 6 and 12 months of treatment. Results: More patients had the initial seizure in juveniles than in adults, and 40.72% of the 2192 patients were not receiving any treatment before the treatment trial. The efficacy of phenobarbital increased and adverse effects decreased within the treatment period. Among the 349 patients who were followed up for 12 months from the beginning of the phenobarbital treatment, seizures were decreased by more than 75% in 71.3% of patients using a low-to-medium dose of phenobarbital. Major adverse effects of phenobarbital included mild exhaustion, drowsiness, dizziness and headache. Conclusions: Standardized long-term and regular administration of phenobarbital at a low-to-medium dose can be used as an effective, economic and safe treatment against epilepsy in rural areas.     

托吡酯治疗癫癎的长期疗效观察

目的观察托吡酯治疗不同类型癫癎的长期疗效及安全性.方法采用开放性试验的方法,给予115例不同类型癫癎患者托吡酯单药或添加治疗,6个月后进行疗效评定,1年和2年时计算控制率和托吡酯保留率,记录不良反应.结果 (1) 6个月时总有效率单药治疗组为83.9%,添加治疗组为66.1%,对各型癫癎均有一定疗效,各组间发作控制率和总有效率比较差异无显著性;(2)稳定期儿童组有效剂量为(105.72±48.28) mg/d,成人组为(176.36±62.81) mg/d;(3)控制率1年为40.0%,2年为28.7%;保留率1年为67.8%,2年为46.1%;(4)34例(29.6%)出现不良反应,为轻、中度的中枢神经系统症状以及厌食和体质量减轻.结论托吡酯是较好的广谱抗癫癎药物,长期应用仍有较好的疗效和安全性.