左乙拉西坦单药治疗成人癫60例临床研究

目的:研究左乙拉西坦(LEV)单药治疗成人癫的临床疗效及副作用。方法:对60例成人癫患者进行LEV单药治疗的开放性自身对照研究,根据发作类型分为部分性发作组35例和全面性发作组25例,观察其疗效及副作用。结果:LEV单药治疗后癫发作完全控制率21.7%,有效率50%;部分性发作组完全控制率17.1%,有效率45.7%,全面性发作组完全控制率28%,有效率56%,2组间疗效比较差异无统计学意义。11例出现不良反应,包括嗜睡、头晕、食欲下降和兴奋激动,均可耐受。结论:LEV单药治疗成人各类型癫均有疗效,不良反应轻。     

奥卡西平对癫痫患者精神状态的影响

目的观察奥卡西平对癫痫患者的癫痫发作次数和精神状态的影响。方法分别记录17例癫痫患者单用奥卡西平前、后3个月内的发作次数,以及治疗前、后患者症状自评量表(SCL-90)分值。结果对影响癫痫患者精神状态的因素进行多元逐步回归分析,发现性别是影响该组患者精神量表总分的主要因素。入组患者治疗后3个月内癫痫发作次数较治疗前减少80%～100%,经非参数检验分析有统计学差异(P<0.05);治疗前、后的SCL-90分值分别为155.94±59.64和134.00±50.21,差异具有统计学意义(P<0.05)。奥卡西平治疗前后SCL-90改善程度无效占17.6%,有效占47.1%,显效占35.3%。治疗前后SCL-90的改善主要与焦虑、人际关系敏感、强迫症状及其他附加项目这4个因子的改善程度有关(P<0.05)。结论奥卡西平不仅能够有效控制癫痫患者部分性发作,还对癫痫患者并存的精神症状有较好的疗效。     

小剂量丙戊酸联合奥卡西平治疗老年癫痫46例疗效分析

目的分析小剂量丙戊酸联合奥卡西平对老年癫痫患者的疗效。方法选取92例老年癫痫患者,根据不同治疗方案将其纳入奥卡西平组(46例)与丙戊酸+奥卡西平组(46例)。奥卡西平组予以奥卡西平治疗,丙戊酸+奥卡西平组予以小剂量丙戊酸联合奥卡西平治疗。对比两组患者的癫痫发作情况(发作次数、发作持续时间)、临床疗效、脑电图变化(痫样放电、累及导联数)、脑电图改善效果。结果丙戊酸+奥卡西平组的癫痫发作次数与发作持续时间[(0.45±0.17)次/月、(1.21±0.56)分钟/次]均少于奥卡西平组[(0.86±0.33)次/月,(2.25±0.84)分钟/次)],P<0.05;丙戊酸+奥卡西平组的总有效率(93.48%)高于奥卡西平组(78.26%),P<0.05;丙戊酸+奥卡西平组治疗后脑电图的痫样放电与累及导联数[(7.38±1.43) t/180 s、(3.45±1.29)/180s]均优于奥卡西平组[(10.20±2.16) t/180s、(5.50±1.52)/180s,P<0.05];丙戊酸+奥卡西平组的脑电图总改善率(91.30%)高于奥卡西平组(73.91%),P<0.05。结论小剂量丙戊酸联合奥卡西平对老年癫痫患者的疗效显著,可明显减少癫痫发作次数与发作持续时间。     

奥卡西平联合丙戊酸钠治疗对青年难治性部分性癫痫患者认知功能的影响

目的探讨奥卡西平联合丙戊酸钠治疗对青年难治性部分性癫痫(RPE)患者认知功能的影响。方法选取收治的100例青年RPE患者为研究对象,按随机数字表法分为对照组和观察组各50例,对照组给予丙戊酸钠治疗,观察组在对照组的基础上给予奥卡西平治疗,连续治疗6个月,比较两组临床疗效、癫痫发作频率、认知功能评分及临床不良反应。结果观察组临床治疗总有效率(92.00%)明显高于对照组(68.00%),差异有统计学意义(P0.05);观察组和对照组临床不良反应发生率均较低,分别为8.00%和6.00%,两组比较无明显差异(P0.05);两组治疗后3、6个月的癫痫发作频率明显低于同组治疗前水平(P0.05),且观察组低于对照组(P0.05);两组治疗后3、6个月的MoCA评分明显高于同组治疗前水平(P0.05),且观察组高于对照组(P0.05)。结论奥卡西平联合丙戊酸钠治疗青年难治性部分性癫痫的疗效确切,可明显改善患者的认知功能,降低癫痫发作频率,且临床安全性较好,值得推广应用。     

托吡酯治疗小儿癫癎的疗效评估

目的:探讨托吡酯单药或添加治疗小儿癫癎的疗效.方法:对28例癫癎患儿进行观察,其中全身性发作10例,部分性继发全身性发作4例,复杂部分性发作8例,简单部分性发作4例,婴儿痉挛症2例;应用托吡酯单药或添加治疗,进行自身对照的开放性研究,观察持续治疗6个月的疗效和不良反应.结果:24例(85.7%)发作频率减少≥50%,19例(67.8%)发作减少≥75%,12例(42.8%)发作控制.最常见不良反应为中枢神经系统表现.结论:托吡酯治疗小儿癫癎安全、有效、耐受性好.     

维拉帕米对难治性癫大鼠的疗效及海马P-糖蛋白表达的影响

目的:观察耐药蛋白抑制剂维拉帕米对难治性癫大鼠的疗效及海马P-糖蛋白表达的影响。方法:Wistar大鼠50只,随机分为生理盐水组(NS组)、匹罗卡品组(PILO组)、卡马西平组(CBZ组)、低剂量维拉帕米组(LDV组)和高剂量维拉帕米组(HDV组),氯化锂-匹罗卡品腹腔注射制作大鼠自发性癫模型,选择耐药癫大鼠,分别给予常规或添加维拉帕米抗癫治疗,观察大鼠性发作频率及海马P-糖蛋白表达的变化。结果:与NS组相比,其它4组大鼠性发作频率增高,海马P-糖蛋白表达增强(P0.05);LDV组和HDV组大鼠的性发作频率及海马P-糖蛋白表达较PILO组和CBZ组降低(P0.05);PILO组和CBZ组大鼠性发作频率及海马P-糖蛋白表达无明显差异,LDV组和HDV组大鼠性发作频率及海马P-糖蛋白表达无明显差异。结论:添加维拉帕米治疗可明显减少难治性癫大鼠性发作频率,降低难治性癫大鼠海马P-糖蛋白的表达。     

奥卡西平治疗婴幼儿部分性癫痫的疗效及对免疫功能的影响分析

目的分析奥卡西平混悬液治疗3岁以下婴幼儿(≤3岁)部分性癫痫的疗效及对免疫功能的影响。方法选择2012年5月至2016年1月接受治疗的部分性发作癫痫婴幼儿(≤3岁)138例,给予奥卡西平混悬液口服治疗,初始用量8~10mg/(kg·d),每7天增加10 mg/(kg·d),直到最小有效药物用量;一般稳定维持药物用量在20~40mg/(kg·d);分析药物有效率及完全控制情况、不良反应发生情况;在治疗前,治疗后第3、6个月清晨空腹状态下抽取患儿血液检测免疫球蛋白以及免疫功能因子;选择同期接受健康体检的3岁以下儿童作为对照组。结果患儿服药后1~3月、4~6月、7~9月完全控制率为41.48%、44.44%、54.07%,总有效率为80.74%、83.70%、85.93%;25例出现不良反应,发生率18.52%;观察组治疗前IgA、IgG、ICAM-1、CD3+、CD4+及CD8+与对照组比较差异有统计学意义(P0.05);与治疗前比较,观察组治疗3、6个月IgA、IgG、ICAM-1、CD3+、CD4+、CD8+差异有统计学意义(P0.05)。结论婴幼儿部分性癫痫使用奥卡西平混悬液治疗,临床效果良好,不仅能够有效减少癫痫发作频次,还能促使其免疫状态趋于正常,而且不良反应较少,患儿治疗依从性较好。     

奥卡西平联合左乙拉西坦对成人颞叶癫痫患者认知功能障碍及生活质量的影响

目的：探讨奥卡西平联合左乙拉西坦对成人颞叶癫痫患者认知功能和生活质量的影响。方法：选取2018年12月~2019年10月接诊的64例成人颞叶癫痫患者,随机分为对照组和观察组,各32例。对照组给予左乙拉西坦治疗,观察组在对照组基础上联合奥卡西平治疗,均治疗3个月。比较两组临床疗效、认知功能和生活质量。结果：观察组患者总有效率（100.00%）高于对照组（84.38%）（P＜0.05）;治疗后,两组患者韦氏成人智力量表、癫痫患者生活质量评定量表-31评分均较治疗前升高,且观察组高于对照组（P＜0.05）。结论：奥卡西平联合左乙拉西坦治疗成人颞叶癫痫,可有效减少患者癫痫发作次数,改善患者认知功能,提高其生活质量。     

癫持续状态27例诊治分析

目的探讨惊厥性癫持续状态的诊断及治疗方法,改善患者预后。方法回顾性分析27例惊厥性癫持续状态患者的临床资料。结果惊厥性癫持续状态其病因以脑血管病、特发性癫自行停药或减药、脑炎及脑外伤等为主;多数患者地西泮、丙戊酸、苯巴比妥钠等抗癫药物治疗有效,症状控制不良者给予丙泊酚可控制疾病发作;本组治愈23例,死亡3例,自动出院1例。结论癫持续状态多因脑血管病和特发性癫患者不规律服药所引起,脑炎及脑外伤也是常见病因;发作早期地西泮、苯巴比妥钠有良好治疗效果,丙泊酚可作为难治性癫持续状态的首选药物。     

左乙拉西坦与奥卡西平治疗成人部分性发作癫痫的疗效比较

目的比较左乙拉西坦、奥卡西平治疗成人部分性发作癫痫的临床效果。方法选取本院收治的142例成人部分性发作癫痫患者作为研究对象,采用电脑随机分组法分成2组,每组71例。对照组采用左乙拉西坦治疗,观察组采用奥卡西平治疗,比较2组患者的疗效、治疗前后脑电图变化和不良反应发生率。结果观察组总有效率为81.69%,对照组为69.01%,差异无统计学意义(P 0.05);治疗后,观察组θ频段相对功率为(30.76±6.84)%,高于对照组的(22.03±6.72)%,差异有统计学意义(P 0.05);观察组癫痫样放电(IEA)减少大于50%者比率为60.56%,对照组为54.93%,差异无统计学意义(P 0.05);观察组不良反应发生率为9.86%,对照组为12.68%,差异无统计学意义(P 0.05)。结论左乙拉西坦、奥卡西平治疗成人部分性发作癫痫均疗效确切,安全性良好,可明显抑制IEA,其中奥卡西平对脑电图活动的影响更大。     

A cost comparison of alternative regimens for treatment-refractory partial seizure disorder: an econometric analysis

BACKGROUND: Partial seizure disorder is typically treated by monotherapy with antiepileptic drugs (AEDs). However, when the condition is refractory to the initial treatment regimen, patients may be switched to monotherapy with another AED or to combination therapy with the initial AED plus a second AED. OBJECTIVES: The purpose of this study was to examine the economic costs associated with treatment-refractory partial seizure disorder and to compare the costs of 2 alternative approaches: a switch to oxcarbazepine (OXC) monotherapy or the addition to the regimen of another AED (AED add-on). METHODS: Adult patients with a diagnosis of partial seizure disorder who received initial AED monotherapy between January 1, 2000, and March 31, 2003, were identified from the PharMetrics Patient-Centric Database, a health plan administrative claims database. The medical and pharmacy history of these patients was analyzed from 6 months before a change to either OXC monotherapy or AED add-on therapy through 12 months after the change in treatment. Total health care resource utilization and the associated costs were compared within each cohort before and after the change, as well as between cohorts, with statistical differences tested using Wilcoxon rank sum tests. Multivariate econometric analyses were performed to examine the impact of age, sex, geographic location, Charlson Comorbidity Index, and the presence of specific comorbidities. RESULTS: Demographic and clinical characteristics 102 were similar between the OXC monotherapy cohort (n = 259) and the AED add-on cohort (n = 795). Annual direct treatment costs increased in both groups in the period after the failure of initial monotherapy, increasing from 10,462 US dollars to 11,360 US dollars in the OXC cohort and from 10,137 US dollars to 12,201 US dollars in the AED add on cohort (P < 0.01). Increased pharmacy costs were the primary driver behind cost increases in both cohorts. Patients in the AED add-on cohort were significantly more likely to have an emergency department visit during the period after the failure of initial monotherapy compared with the OXC monotherapy cohort (odds ratio = 1.52; P < 0.05). CONCLUSION: Despite limitations, the results of retrospective analysis of claims data suggest that the care of patients with treatment-refractory partial seizure disorder is costly and may vary significantly based on the pattern of care.     

丙戊酸镁缓释片治疗癫痫的临床观察

目的观察丙戊酸镁缓释片治疗各种类型癫痫的疗效和安全性。方法分别用单药和添加治疗各类癫痫患者88例,添加组39例,在原有抗癫痫药基础上,按成人每日0.5～1.5g,儿童15～30mg·kg^-1·d^-1,于早、晚两次口服丙戊酸镁缓释片;单药组49例,成人起始剂量为每日口服丙戊酸镁缓释片0.5g,每周增加剂量不超过0.5g,最大剂量不超过每日2.0g;儿童按15～30mg·kg^-1·d^-1,最大不超过40mg·kg^-1·d^-1。服药24周根据发作频率减少情况进行疗效评定。结果对各种类型的癫痫发作治疗总控制率为43.2%,总显效率为23.9%,总有效率为81.8%,无一例出现发作次数增多。单药治疗组控制率为51.0%,显效率为22.4%,总有效率为83.7%;添加治疗组控制率为33.3%,显效率为25.6%,总有效率为79.5%。两组相比,单药组治疗效果略高于添加治疗组,但差异无统计学意义。单药治疗疗效较为明显者为失神发作、强直发作、肌阵挛发作、失张力发作等,而局灶性发作仅占50.0%;添加治疗组其疗效较为明显者是继发强直阵挛性发作（90.0%）。不良反应主要为头昏、体重增加、嗜睡、脱发、血小板减少、一过性氨基转移酶升高等,多数患者反应较轻,只要从小剂量开始,加药速度慢,注意肝功能等检查,就能够坚持服药。虽然此药比较安全,但在发育期女性及孕妇中应用仍然要慎重。随访一年以上患者依从性较好。结论丙戊酸镁缓释片具有较好的临床疗效和药物依从性,是较理想的抗癫痫药物。     

托吡酯治疗各型癫痫的临床疗效观察

目的：观察及评价托吡酯对各型癫痫的临床疗效及安全性。方法：对2000年1月至2002年12月在该院确诊的105例癫痫患者中的72例采用托吡酯添加治疗、33例单药治疗，经8周加量期和12周稳定期观察后进行评价。结果：添加治疗组及单药治疗组总有效率分别为72．2％和84．8％，完全控制率分别为27．8％和45．5％。无明显不良反应。结论：托吡酯是一种广谱、有效及安全的新型抗癫痫药。     

理想的抗癫癎治疗:传统和新型抗癫癎药物的特性与应用

癫痫的治疗以药物为主，近年来随着新型抗癫痫药物的不断涌现，癫痫的治疗目标由强调发作的控制转为强调生活质量提高的个体化治疗，因此抗癫痫药物的选择必须以发作类型为基础，同时考虑药物的疗效、耐受性等特性，本文对传统及新型抗癫痫药物的特性及其在癫痫治疗中的合理应用进行综述。     

脑梗死后迟发性癫痫：附33例分析

目的：探索脑梗死后迟发性癫痫的临床特点。方法：对３３例脑梗死后迟发性癫痫的临床资料进行分析。结果：脑梗死后迟发性癫痫发生率为３．６％（３３／９１６）。其中７０％（２３／３３）发生在脑梗死后半年内,而大发作者占５２％（１７例）。部分性发作表现多样。抗癫痫治疗８２％（２７例）有效。结论：脑梗死后迟发性癫痫多发生在脑梗死后半年内,临床表现多样,无抽搐病例易误诊,抗癫痫治疗效果佳。     

维生素辅助治疗儿童癫痫56例疗效观察

目的:观察抗自由基药物(VE和VC)辅助治疗儿童癫痫的疗效。方法:癫痫患者56例,所有病例均符合国际抗癫痫联盟癫痫的诊断标准,随机分为传统抗癫痫药组(18例)、传统抗癫痫药+VE组(19例)、传统抗癫痫药+VC+VE组(19例),检测各组治疗前后静脉血中总抗氧化力(T-Aoc)及丙二醛(MDA)的平均水平。结果:(1)传统抗癫痫药+VE组静脉血中T-Aoc的平均水平较传统抗癫痫药组高,P<0.05;MDA的平均水平较传统抗癫痫药组低,P<0.05。(2)传统抗癫痫药+VC+VE组T-Aoc的平均水平较传统抗癫痫药+VE组高,但P>0.05,无统计学意义;MDA的平均水平较传统抗癫痫药+VE组低,P<0.05。(3)传统抗癫痫药+VC+VE组、传统抗癫痫药+VE组、传统抗癫痫药组治疗后的总有效率分别为68.4%、63.2%、55.6%。结论:对癫痫患儿加用抗自由基药物(VE和VC)作为辅助治疗,在血液指标与疗效方面可能优于未加者。VE、VC联合应用能起到协同效应,二者联合可能增强了抗氧化效果与抗癫痫作用。     

Levetiracetam: a new therapeutic option for refractory epilepsy

Levetiracetam (LEV) is the most recently licensed antiepileptic drug (AED) for adjunctive therapy of partial seizures. Its mechanism of action is uncertain but it exhibits a unique profile of anticonvulsant activity in models of chronic epilepsy. Three randomised, double-blind, placebo-controlled trials enrolling 904 patients with refractory partial epilepsy have demonstrated the efficacy of LEV as adjunctive therapy, with a responder rate (> or = 50% reduction in seizure frequency) of 28-41%. Long-term efficacy studies suggest retention rates of 60% after one year, with 13% of patients seizure-free for six months of the study and 8% seizure-free for one year. Adverse effects of LEV, including somnolence, lethargy and dizziness, were generally mild and the frequency of incidents was not significantly different between the active treatment and placebo groups in clinical trials. LEV has no clinically significant pharmacokinetic interactions (PKI) with other AEDs, or with commonly prescribed medications. Preliminary data suggest that LEV has efficacy in primary generalised epilepsy and further randomised trials are under way. The combination of potent antiepileptic properties with a relatively mild adverse effect profile makes LEV an attractive adjunctive therapy for partial seizures.     

氟桂利嗪添加治疗难治性癫痫的临床研究

目的探讨氟桂利嗪添加治疗难治性癫痫的疗效。方法随机、双盲对照添加治疗,从我院癫痫病人数据库中随机抽取确诊为难治性癫痫患者52例,随机分配入氟桂利嗪添加活疗组（n=26）与安慰剂组（n=26）。疗程1月后,分别比较两组疗效差别及每组自身治疗前后差别。结果两组于受试期结束后发作频率比较,差异有统计学意义（x^2=5．20,P〈0．05）。治疗组在第二周末、第四周末与基线期自身比较,差异有统计学意义（t=2．40、2．81,P均〈0．05）。结论氟桂利嗪作为难治性癫痫的添加治疗有一定疗效,无明显不良反应,但需进一步扩大样本深入研究。     

Epilepsy

Seizures are common and are treated in all branches of medicine. Approximately 10% of the population will have one or more seizures during their lifetime. Seizures are symptoms that occur in acute illness, ie, provoked seizures, or in epilepsy, ie, unprovoked seizures. Epilepsy is any disorder in which spontaneous recurrence of unprovoked seizures is the main symptom. It is a common chronic neurologic disorder and affects 1% to 3% of the population. Classification of seizure type is important because it enables identification of the region of the brain where the seizure originated and guides initial diagnostic testing. Classification of epilepsy syndrome, rather than only type of seizure, is more important. Epilepsy syndromes are defined by many factors, including type of seizures, age at onset of seizures, family history of seizures, and findings at physical examination, electroencephalography (EEG), and neurologic imaging studies. Identifying the epilepsy syndrome provides insight into natural history, prognosis, diagnostic testing, and therapy of the disorder and facilitates communication between health care professionals. Understanding seizure type provides useful information even when the epilepsy syndrome cannot be classified. Many sudden events are easily confused with seizures, in particular, pseudoseizures, syncope, migraine, cerebrovascular disease, movement disorders, and sleep disorders. In most cases a detailed history and physical examination concentrated on the details of the event, and results of routine EEG and magnetic resonance imaging can aid in determination of which events are seizures. Video EEG monitoring is occasionally necessary to capture events to enable definitive determination of whether they are seizures and to further characterize them. Provoked seizures are treated with relief of the provoking factor. Antiepileptic drugs (AEDs) are not indicated. However, AEDs may be required to treat unprovoked seizures of new onset in patients at high risk for seizure recurrence or when a second seizure can have devastating psychosocial effects. High risk for recurrence is present when there is a history of brain insult, an EEG demonstrates epileptiform abnormalities, and magnetic resonance images demonstrate a structural lesion. AED therapy is the standard treatment for epilepsy, ie, two or more seizures. Selection of the appropriate AED depends on type of seizure and epilepsy present, and individual drug characteristics, including pharmacokinetics, side effects, dosing interval, and cost. All available AEDs except ethosuximide are effective as adjunctive therapy, and most are effective as initial monotherapy for partial seizures. Generalized seizures preferentially respond to valproate, lamotrigine, and topiramate, among other drugs. If trials of more than two AEDs do not control seizures, additional AEDs are unlikely to be effective, and the patient should be referred to an epilepsy center, where other treatment options, in particular, epilepsy surgery, can be offered. Epilepsy surgery renders 60% to 70% of patients with temporal lobe epilepsy free of disabling seizures.