丙戊酸联合拉莫三嗪治疗癫痫的疗效分析

目的观察和分析丙戊酸联合拉莫三嗪治疗癫痫的临床疗效效果。方法选取2013年5月至2014年5月我院收治的80例癫痫患者,按照随机分配原则将患者分为实验组和对照组,每组40例,对两组癫痫患者分别给予丙戊酸治疗,实验组在此基础上结合拉莫三嗪治疗,经过6个月的治疗后,对比两组患者的临床疗效效果。结果两组患者治疗效果的总有效率对比,实验组的总有效率为85%,对照组的总有效率为70%,实验组的总有效率明显高于对照组(P<0.05);两组患者的不良反应发生率对比,实验组的不良反应发生率为10%,对照组的不良反应发生率15%,实验组的总有效率明显低于对照组(P<0.05),差异具有统计学意义。结论丙戊酸联合拉莫三嗪治疗癫痫的疗效效果比丙戊酸治疗癫痫的疗效效果明显,不良反应发生率比较低,值得临床推广。     

丙戊酸联合拉莫三嗪治疗癫痫的效果观察

目的探讨丙戊酸联合拉莫三嗪治疗癫痫的效果。方法选取96例癫痫患者,分为对照组和观察组,其中对照组采用丙戊酸治疗,观察组采用丙戊酸联合拉莫三嗪治疗;通过分析患者的症状改善程度及药物不良反应,评估采用丙戊酸联合拉莫三嗪治疗癫痫的效果。结果观察组完全控制26例,有效19例,无效3例,临床总有效率为93.75%;对照组完全控制14例,有效23例,无效11例,临床总有效率为77.08%,两组差异具有统计学意义(P<0.05)。观察组总不良反应发生率14.58%,对照组总不良反应发生率10.42%;两组差异无统计学意义(P>0.05)。结论采用丙戊酸联合拉莫三嗪治疗癫痫,效果确切,可协同控制患者的病情,改善患者的预后,不良反应发生少且轻微,治疗安全性高。     

丙戊酸联合拉莫三嗪治疗癫痫的疗效性分析

目的对丙戊酸联合拉莫三嗪在癫痫患者临床治疗中的疗效和安全性分析。方法临床选取我院在2013年6月至2014年6月实施治疗的38例癫痫患者,并将其分成两组,实施不同临床治疗方法,对比分析对照组和观察组患者的治疗效果。结果对照组和观察组患者的临床治疗总有效率分别为73.68%、94.74%,二者差异显著(P<0.05);观察组患者的临床治疗不良反应发生率明显低于对照组,二者差异显著(P<0.05)。结论丙戊酸联合拉莫三嗪治疗癫痫效果显著,值得临床推广。     

丙戊酸钠联合拉莫三嗪治疗癫痫的临床效果

目的：探讨丙戊酸钠联合拉莫三嗪治疗癫痫的临床效果。方法选择收治的癫痫患者116例,并随机分为观察组与对照组各58例,对照组中患者以丙戊酸钠缓释片对其进行治疗,观察组中患者在对照组基础上联合拉莫三嗪对其进行治疗,比较两组临床疗效。结果观察组总有效率94.8%（55/58）,明显高于对照组72.4%（42/58）,比较差异具有统计学意义（P＜0.05）;两组患者在治疗中以及完成治疗后均无严重不良反应发生。结论丙戊酸钠联合拉莫三嗪治疗癫痫,效果明显,能使患者的临床症状得到显著改善,提高其生活质量。     

不同类型儿童癫痫采取丙戊酸钠联合拉莫三嗪治疗的临床对比

目的：探讨不同类型儿童癫痫治疗方案。方法：选取120例于2014年8月～2015年8月我院接收的小儿难治性癫痫患者,根据疾病类型分为四组,即部分发作型（PS）组（n=46）、全面性发作（GS）组（n=30）、部分继发全面发作（SGS）组（n=33）、Lennox Gastaut综合征（LGS）组（n=11）,治疗方案均为在丙戊酸钠基础上加用拉莫三嗪,观察疗效。结果：四组治疗后临床疗效比较无明显差异（P>0.05）;各组治疗后6个月、12个月时癫痫发作频率明显减少（P<0.05）。结论：小儿难治性癫痫采取拉莫三嗪联合丙戊酸钠治疗,疗效较佳,药物副反应少,具有推广价值。     

丙戊酸钠联合拉莫三嗪治疗成人难治性癫痫的疗效分析

目的探讨丙戊酸钠联合拉莫三嗪治疗成人难治性癫痫的临床疗效及安全性。方法将笔者所在医院收治的118例难治性癫痫患者随机分为治疗组和对照组,各59例。对照组单纯给予VPA,治疗组在此基础上加用LTG。结果治疗组总有效率为96.6%,显著优于对照组的84.8%,差异有统计学意义(P<0.05);且未见明显不良反应。结论 VPA联合LTG治疗成人难治性癫痫疗效确切,安全性高,可提高患者的生存质量。     

癫痫患者丙戊酸与拉莫三嗪药代动力学相互作用研究

目的 考察癫痫患者合用丙戊酸(VPA)与拉莫三嗪(LTG)的药代动力学相互作用.方法 将纳入的癫痫患者随机分为3组:VPA组276例、LTG组254例和合用组334例.VPA组患者每天口服VPA 500～1000 mg,LTG组每天口服LTG 100～200 mg,合用组用VPA+LTG.高效液相色谱-质谱联用法测定V...     

不同剂量拉莫三嗪治疗老年癫痫的比较研究

目的 探讨不同剂量拉莫三嗪治疗老年癫痫患者的临床疗效。方法 选择2014年7月—2018年2月洛阳市第三人民医院神经内科诊治的老年癫痫患者88例作为研究对象,根据拉莫三嗪使用剂量分为对照组（40例）和观察组（48例）。对照组患者给予大剂量拉莫三嗪片治疗,拉莫三嗪起始剂量25 mg/d,2周后为50 mg/d,第5周以后为目标剂量100 mg/d,维持100 mg/d治疗观察至第8周。观察组患者给予小剂量拉莫三嗪片治疗,起始剂量25 mg/d,2周后为50 mg/d,第5周以后为目标剂量50 mg/d,维持50 mg/d治疗观察至第8周。观察两组患者的临床疗效,同时比较两组患者蒙特利尔认知评估量表（MoCA）评分、P300潜伏期、波幅和不良反应情况。结果 治疗后,对照组和观察组总有效率分别为97.5%、97.9%,两组对比差异无统计学意义。治疗后,两组患者的MoCA评分均显著高于治疗前,同组治疗前后比较差异具有统计学意义（P<0.05）;且观察组治疗后的MoCA评分显著高于对照组,两组比较差异具有统计学意义（P<0.05）。治疗后,观察组的P300潜伏期显著降低,波幅明显升高,同组治疗前后比较差异具有统计学意义（P<0.05）;且观察组治疗后P300潜伏期及波幅显著优于对照组,两组比较差异具有统计学意义（P<0.05）。观察组治疗期间的不良反应发生率为6.3%,显著低于对照组的32.5%,两组比较差异具有统计学意义（P<0.05）。结论 相对于大剂量,小剂量拉莫三嗪治疗老年癫痫患者能达到很好的疗效,能减少不良反应的发生,改善患者的神经电生理功能与认知功能。     

拉莫三嗪和丙戊酸钠联合治疗儿童难治性癫痫临床研究

目的:了解丙戊酸钠(VPA)和拉莫三嗪(LTG)治疗儿童难治性癫痫的疗效.方法:收集儿童难治性癫痫21例,已在使用VPA且血药浓度在有效范围内(50～100 μg/mL)者,即从0.15 mg/(kg·d)、1次/d开始加LTG,第1个月每周增加0.2 mg/(kg·d),第2个月每周增加0.3 mg/(kg·d),以后每周增加0.5～1 mg/(kg·d),直至发作控制或剂量迭10 mg/(kg·d).未使用VPA者,从20 mg/(kg·d)开始加VPA,并调整血药浓度至50～100 μg/mL,再逐渐减停其它抗癫痫药物,加LTG,方法同上.随访发作情况,监测不良反应.结果:治疗9个月时10例(47.6%)完全控制,5例(23.8%)有效,6例(28.6%)无效,治疗后发作频率减少,差异有统计学意义(P<0.005),5例(23.8%)脑电图恢复正常,8例(38.1%)出现不良反应.结论:LTG和VPA联用为一种有效、安全而经济的治疗小儿难治性癫痫的方法.     

The tolerability of lamotrigine in elderly patients with epilepsy

OBJECTIVE: To determine the tolerability of lamotrigine in elderly patients with epilepsy. DESIGN: Pooled data from 13 lamotrigine clinical trials. SETTING: Multicentre clinical trials conducted in primary care and neurology practices. PARTICIPANTS: 208 elderly patients (aged > or = 65 years) were identified: 146 lamotrigine-treated patients, 53 carbamazepine-treated patients and 9 phenytoin-treated patients. INTERVENTIONS: Extent of exposure, incidence of drug-related adverse events, serious adverse events and study withdrawals were examined. RESULTS: The median duration of exposure for lamotrigine monotherapy and add-on therapy was 24.1 and 47.4 weeks, respectively. The median daily dosage of lamotrigine was 100 mg for monotherapy (range 75 to 500 mg) and 300 mg for add-on therapy (range 25 to 700 mg). Overall, the incidence of drug-related adverse events was lower for lamotrigine than comparator drugs: 49% (72/146) for lamotrigine compared with 72% (38/53) for carbamazepine (p = 0.006), and 89% (8/9) for phenytoin (p = 0.035) although patient numbers in each treatment group were not comparable. Patients receiving lamotrigine reported incidences of somnolence (p = 0.012), rash (p = 0.034), and headache (nonsignificant) that were one-half the incidence reported with carbamazepine monotherapy. Rash was the most common reason for study withdrawal: 4% (6/146) lamotrigine, 17% (9/53) carbamazepine and 0% phenytoin. Seven (5%, 7/146) lamotrigine-treated patients, 4 (8%, 4/53) carbamazepine-treated patients and 1 (11%, 1/9) phenytoin-treated patient experienced drug-related serious adverse events. CONCLUSION: Lamotrigine, used in the currently prescribed adult dosage regimen, was well tolerated in elderly patients with epilepsy.     

丙戊酸钠联合拉莫三嗪治疗不同类型儿童癫痫的临床对比

目的 观察丙戊酸钠联合拉莫三嗪治疗不同类型儿童癫痫的临床效果.方法 选取本院收治的儿童癫痫患者127例,根据癫痫类型分为部分发作型(PS)组(52例)、部分发作继发全面发作(SGS)组(37例)、全面性发作(GS)组(28例)和Lennox Gastaut综合征(LGS)组(10例).所有患者均给予丙戊酸钠联合拉莫三嗪治疗,观察各组临床治疗效果.结果 SGS组完全控制率为35.14％,明显高于其他3组(P＜ 0.05);LGS组全控制率最低,为0.00％.SGS组治疗总有效率为64.86％,明显高于其他3组(P＜0.05);LGS组治疗总有效率最低,为30.00％.与治疗前比较,各组发作频次均有不同程度减少,差异均有统计学意义(P＜0.05).结论 丙戊酸钠联合拉莫三嗪治疗不同类型儿童癫痫均有不同程度的效果,均能够显著减少患儿癫痫发作次数,其中以SGS疗效最为明显.     

Preliminary observations on valproic acid kinetics in patients with epilepsy.

A rapid gas chromatographic method for determination of sodium valproic acid (di-n-propylacetate, DPA) is described. A new sample can be injected every third min, and the reproducibility, in terms of the coefficient of variation, is better than 3%. The method has been used to study clinical pharmacokinetics of DPA in patients with epilepsy during long-term treatment. A poor correlation between daily dose (mg/kg) of DPA and steady state serum levels, attained within few days, was observed. A fixed sampling time in the individual patient, preferably before ingestion of the morning dose, is of great importance for DPA due to extended fluctuations of the serum levels during the day. Most patients had DPA serum levels in the order of 50 microng/ml. No constant relationship was found between increase of the dose and the corresponding increase of the serum levels. Interactions of clinical importance was observed between DPA and other antiepileptic drugs, as addition of DPA resulted in elevated serum levels of diphenylhydantoin and phenobarbital. Carbamazepine levels were unaltered. After withdrawal of DPA the half-life was about 14 h in adult patients. DPA levels in CSF were in the order of 10% of the corresponding serum levels.     

Monitoring free valproic acid in epilepsy patients medicated with coanticonvulsants

Methodology for monitoring free valproic acid (VPA) and experimental proof of intrapatient in vivo diurnally and disproportionately variable free VPA fractions has recently been reported. An inherent assumption in accepting therapeutic VPA plasma levels to be 50-100 micrograms/ml is that free fractions remain constant. This assumption is no longer tenable. Therefore, monitoring only VPA plasma levels could be misleading. The serial 9-h time-course (7 a.m. 0 10-1-4 p.m.) of free versus plasma VPA levels was investigated in 24 patients. Limits for diurnal fluctuations were (mean +/- SD): Group A (n = 14); 49.0 mg/kg; multiple equal dosing: Free VPA (micrograms/ml) 6.06 (1.55 to 12.62 (4.89), plasma VPA (micrograms/ml) 52.9 (11.6) to 84.2 (21.3), percent free VPA 11.5 (1.8) to 14.9 (2.5). Group B (n = 10); 30.6 mg/kg; b.i.d.: 12.0 (2.4) mg/kg a.m. and 18.7 (3.3) mg/kg p.m.: Free VPA 5.53 (1.04) to 9.92 (1.51), plasma VPA 52.0 (7.3) to 79.2 (9.6), percent free VPA 10.7 (1.6) to 12.5 (0.8). Reducing the dosage by 19 mg/kg (A to B) decreased VPA plasma levels by 6.9% nd free VPA levels by 28.9%. For B: y = 8.15 + 4.03 x; n = 10, r = 0.954, Sy.x = 1.38, when x = steady-state (7 a.m.) free VPA concentration and y = VPA mg/kg/day. The findings suggest that multiple dosing is unnecessary. Similar plasma levels with far less diurnal fluctuations of free levels are achievable by a smaller drug dose with approximately two-thirds of total daily dose being administered in the evening and one-third in the morning.     

丙戊酸联合卡马西平治疗小儿癫痫的效果及对认知功能的影响

目的：探讨丙戊酸联合卡马西平治疗小儿癫痫的效果及对认知功能的影响。方法入选2012年6月~2013年2月就诊于本院的小儿癫痫患者98例作为研究对象,对其临床资料进行回顾性分析,按照应用药物不同分为单用A组34例、单用B组22例和联用C组42例,单用A组采用丙戊酸,单用B组采用卡马西平,联用C组采用丙戊酸联合卡马西平,对三组患者的疗效进行评价和分析,同时对药物治疗对认知功能的影响进行探讨。结果单用A组总有效率为67.65%,单用B组总有效率为63.64%,联用C组总有效率为85.71%,三组总有效率比较差异有统计学意义（P＜0.05）。单用A组认知障碍率为29.41%,单用B组认知障碍率为27.27%,联用C组认知障碍率为42.86%,差异有统计学意义（P＜0.05）。结论丙戊酸联合卡马西平较单用两种药物的疗效显著,但联用两种药物对认知功能的损害较严重,临床应注意合理应用,避免因追求疗效而忽视其对认知功能的严重损害。     

Correlation of MCT1 and ABCC2 gene polymorphisms with valproic acid resistance in patients with epilepsy on valproic acid monotherapy

Valproic acid (VPA) is used as one of the first-line antiepileptic drugs to control seizure in epilepsy patients. However, one third of patients do not respond to VPA. This study is to investigate the influence of single nucleotide polymorphisms (SNPs) in multidrug transporters on VPA responses in Han Chinese epilepsy patients on VPA monotherapy. Twelve SNPs involved in VPA transport pathways, including ABCC2, ABCC4, ABCG2, MCT1, MCT2 and OATP2B1 were genotyped in 153 Han Chinese epilepsy patients. We found that among all the patients, MCT1 rs60844753 CC carriers have higher incidence of VPA-resistance than CG carriers (P = 0.05), and in subgroup of generalized seizure, ABCC2 rs3740066 CC carriers had higher frequency of VPA resistance than TC + TT carriers (P = 0.03). Although other SNPs were not correlated with VPA resistance, significant ethnic difference was found in minor allele frequency of these SNPs, indicating that the influence of these SNPs on VPA efficacy should be broadly investigated in other ethnic populations. This study provides nominal evidence that SNPs of genes involved in the transport of VPA contribute to interpatient variation in VPA response. Although the associations were abolished after Bonferroni correction, the results provide an incentive for further research in sufficiently large samples.