添加托吡酯治疗难治性癫痫部分性发作临床疗效的初步观察

目的 观察添加托吡酯对难治性癫痫部分性发作的临床疗效。方法 选择难治性癫痫部分性发作11例,保持原用AEDS不变,逐步递增托吡酯剂量,目标剂量200mg/日。结果 完全控制2例,显效2例,有效4例,无效3例,有效率73％（8／11）。结论 添加托吡酯对难治性癫痫部分性发作有较好疗效。     

头痛宁胶囊联合氟桂利嗪治疗偏头痛临床观察

目的观察头痛宁胶囊联合小剂量氟桂利嗪治疗偏头痛的临床疗效。方法 120例偏头痛患者随机分为治疗组60例和对照组60例,对照组按偏头痛常规口服氟桂利嗪胶囊10 mg每晚睡前服,治疗组给予头痛宁胶囊3粒/次,3次/d,氟桂利嗪胶囊2.5 mg每晚睡前服,2组均连续治疗30 d。结果治疗组总有效率为96.7%,与对照组75%,2组比较差异有统计学意义(P<0.05)。结论头痛宁胶囊联合小剂量氟桂利嗪胶囊治疗偏头痛有较好疗效。     

氟桂利嗪联合养血清脑颗粒治疗偏头痛的临床疗效

目的 探讨氟桂利嗪联合养血清脑颗粒治疗偏头痛的临床疗效.方法 将100例偏头痛患者随机分为治疗组和对照组各50例,治疗组给予养血清脑颗粒4g/次,3次/d,口服;氟桂利嗪5～10mg,每晚睡前服.对照组给予氟桂利嗪5～10mg每晚睡前服.2组均连续治疗30d.结果 治疗组治愈20例,显效10例,有效15例,总有效率90%;对照组治愈10例,显效10例,有效20例,总有效率80%,2组间总有效率比较差异有统计学意义(P＜0.05).结论 氟桂利嗪联合养血清脑颗粒治疗偏头痛是安全有效的.     

托吡酯多中心开放性添加治疗成人难治性癫痫部分性发作的临床观察

目的 评价托吡酯（topiramate,TPM)对难治性癫痫部分性发作的疗效及耐受性。方法 采用多中心开放性试验的方法对全国52家医院的431例病人进行托吡酯添加治疗。本研究包括8周基础期、8周加量期及12周稳定观察期。在8周基础期,病人虽用1－3种抗癫痫药治疗,但仍有每月至少4次的发作;在加量期,TPM开始量为25mg/d,持续1周,以后每周增加25mg/d,直到目标剂量达到200mg/d,维持此剂量12周为稳定观察期。结果 431例病人参加此项研究,其中癫痫发作频率减少≥50％者为326例（75．6％）,≥75％者为257例（59．6％）,减少100％者为91例（21．1％）。18例（4．2％）发作频率增加≥25％。就发作类型而言,癫痫发作频率减少 ≥50％者中,单纯部分性发作（SPS）为83．4％,复杂部分性发作（CPS）为74．4％,部分发作继发全身性发作为82．1％。未出现严重的副作用。结论 TPM对癫痫部分性发作伴有或不伴有继发全身性发作者有效,口服安全。     

泰必利联合氟桂利嗪治疗血管性头痛的疗效分析

目的 观察泰必利并用氟桂利嗪治疗血管性头痛的疗效。方法 随机将80例血管性头痛患者分为两组,每组40例:一组为治疗组,给予泰必利300mg/d及氟桂利嗪5mg/d;另一组为对照组,单纯使用泰必利300mg/d;两组疗程均为1个月,随访6个月。疗效判定按统一的4级标准进行。结果 治疗组显效率为80％,对照组为55％(t=2.34,P<0.05),说明治疗组疗效优于对照组,在副作用方面两组无显著差异。结论 泰必利并用氟桂利嗪治疗血管性头痛疗效确切,值得临床推广应用。     

正天丸与氟桂利嗪联合治疗偏头痛疗效观察

目的 观察正天丸与氟桂利嗪联合治疗偏头痛的临床疗效.方法 将80例偏头痛患者,随机分为2组,治疗组40例,服用正天丸6 g,3次/d,氟桂利嗪10 mg,每晚睡前服;对照组40例,服用氟桂利嗪10 mg,每晚睡前服;2组均连续治疗4周,观察2组疗效,比较有效率.结果 治疗组总有效率92.5% ,其中治愈12例(30.0%),显效15例(37.5%),好转20例(25.0%);对照组总有效率72.5%,其中治愈7例(17.5%),显效13例(32.5%),好转9例(22.5%);治疗组总有效率明显优于对照组(P＜0.05).结论 正天丸与氟桂利嗪联合治疗偏头痛疗效好且不良反应小,值得临床推广.     

妥泰添加治疗难治性癫的临床观察

目的 观察妥泰作为治疗难治性癫的添加剂的疗效及不良反应.方法 临床选取13例难治性癫患者,其中3例全面性强直阵挛发作,9例复杂部分性发作,1例单纯部分性发作.病程均在2年以上;经一线抗癫药物正规治疗1年以上仍频繁发作,每月发作频率均为4次以上;影响日常工作、生活;妥泰用药方法：成人用25mg开始,以后每周加25mg或50mg至发作控制或达到200mg/d;儿童1mg/（kg·d）,以后每周增加1mg/（kg·d）至发作控制或达到5mg/（kg·d）,以后维持观察12周,共20周.结果 经治疗5例发作减少75%以上（显效）,3例发作减少50%（有效）,2例发作减少25%以下（无效）,1例发作增加25%以上（恶化）,2例退出.总有效率61.5%.主要不良反应有厌食、恶心、呕吐、体重减轻、记忆力下降.结论 妥泰作为添加药物对难治性癫疗效较好,特别是对复杂部分性发作,有效率达77.8%.     

川芎清脑颗粒对偏头痛患者血液流变学及疗效的影响

目的：探讨川芎清脑颗粒联合氟桂利嗪对偏头痛患者血液流变学及疗效的影响。方法将97例偏头痛患者随机分为观察组（49例）和对照组（48例），对照组应用盐酸氟桂利嗪治疗，观察组在此基础上应用川芎清脑颗粒治疗，均连续治疗4周。观察2组患者治疗效果及治疗前后血液流变学指标水平。结果观察组治疗总有效率（93.88％）高于对照组（75.00％），差异有统计学意义（P＜0.05）；治疗后，观察组全血黏度（高切）、全血比黏度（低切）及血浆黏度水平均有明显改善，并且上述指标水平也低于对照组，差异有统计学意义（P＜0.05）。结论川芎清脑颗粒联合氟桂利嗪可有效调节血管流变学指标，对偏头痛具有较好的治疗效果。     

针刺联合氟桂利嗪治疗偏头痛临床研究

目的探讨针刺联合氟桂利嗪治疗偏头痛的临床疗效。方法选取87例偏头痛患者,随机分为对照组(45例)和治疗组(42例),对照组口服硫必利片100mg,3次/d,睡前口服氟桂利嗪胶囊5mg,连续服用10d;治疗组针刺百会、双侧风池,患侧悬颅透刺率谷、外关、足临泣,同时睡前口服氟桂利嗪胶囊5mg,连续治疗10d。观察2组治疗2h后的止痛效果和2个月后偏头痛再发率。结果治疗组2h后的疼痛评分显著低于对照组(P0.01),2个月后偏头痛再发率低于对照组(P0.05)。结论针刺联合氟桂利嗪治疗偏头痛疗效显著,再发率低,是一种有效的治疗手段。     

养血清脑颗粒联合氟桂利嗪治疗偏头痛的疗效观察

目的探讨养血清脑颗粒联合氟桂利嗪对偏头痛患者的治疗效果。方法选择98例偏头痛患者为研究对象,随机分为观察组(49例)和对照组(49例),对照组口服氟桂利嗪治疗,10mg/次,1次/d,观察组在此基础上加用养血清脑颗粒,1袋/次,3次/d,2组均连续治疗30d。观察2组治疗前后VAS评分、疼痛持续时间及治疗效果。结果观察组治疗总有效率(91.84%)高于对照组(75.51%),差异有统计学意义(P0.05);观察组VAS评分和疼痛持续时间均低于对照组,差异有统计学意义(P0.05)。结论养血清脑颗粒联合氟桂利嗪治疗对偏头痛疗效显著,具有较好的临床应用价值。     

左乙拉西坦单药或添加治疗癫痫的临床观察

目的观察左乙拉西坦单药和添加治疗癫痫的临床疗效和不良反应。方法对91例门诊癫痫患者进行左乙拉西坦开放性治疗;其中少儿组54例,成人组37例;简单部分性发作(SPS)19例,复杂部分性发作(CPS)20例,全面性强直阵挛性发作(GTCS)32例,继发性全面性强直阵挛性发作(sGTCS)20例;采用单药治疗66例,添加治疗25例。左乙拉西坦起始剂量即为治疗剂量,儿童为10 mg/(kg.d),成人为0.5～3.0 g/d;治疗6个月时根据发作频率自身对照评价疗效,观察不良反应。结果治疗6个月时本组癫痫控制率为52.7%(48例),总有效率为75.8%;少儿组控制率和总有效率分别为64.8%及90.7%,明显高于成人组(35.1%,54.1%;均P<0.01);单药治疗组分别为62.1%及81.8%,明显高于添加治疗组(28.0%,60.0%;均P<0.01);SPS、CPS和GTCS的控制率分别为68.4%和55.0%及53.1%,明显高于sGTCS(35.0%,均P<0.01);SPS控制率明显高于GTCS(P<0.05)。本组不良反应发生率为16.5%,多较轻微,2例因明显脱发而换药。结论左乙拉西坦对多种类型的癫痫发作具有较好的疗效,对儿童及单药治疗的患者疗效更好;儿童及成人患者均有较好的耐受性。     

随机、双盲、安慰剂对照、多中心研究唑尼沙胺添加用药治疗部分性癫(癎)发作的有效性和安全性

目的 评价唑尼沙胺(ZNS)作为添加用药治疗部分性癫(癎)发作的有效性和安全性.方法 采用多中心、随机、双盲、安慰剂对照、平行组、添加治疗设计.240例确诊为癫(癎)部分性发作的受试者按照1:1的比例随机分配到ZNS治疗组或安慰剂组.在前4周加鼋期内受试者自100 mg/d逐渐加量至300 mg/d,随后进入12周的稳定治疗期.在稳定期内可根据患者情况酌情减量,或加量至最大剂量400 mg/d.有效性评价的主要指标为稳定期部分性癫(癎)发作频率较基线值减少百分数的中位值,重要的次要评价指标为有效率,即部分性癫(癎)发作次数减少≥50%者的比例.同时对药物的安全性进行评价.结果 ZNS组受试者稳定期部分性癫(癎)发作频率较基线期减少百分数(48.4%)显著高于安慰剂组(26.6%),组间差异有统计学意义(F=4.904,P=0.028);ZNS组治疗部分性癫(癎)发作的有效率(48.6%)高于安慰剂组(34.9%),差异有统计学意义(X2=4.046,P=0.044),其中以复杂部分性癫(癎)的组间差异最为显著(分别为52.2%和33.3%,X2=5.607,P=0.018).ZNS组与安慰剂组不良事件发生率相当,与ZNS相关的不良事件多为头晕、头痛、嗜睡、食欲下降、恶心等.结论 ZNS能有效治疗部分性癫(癎),降低癫(癎)发作频率,对复杂部分性癫(癎)发作治疗效果尤为突出.ZNS耐受性良好,受试者用药安全性较高.     

Absence of simple partial seizure in temporal lobe epilepsy: its diagnostic and prognostic significance

The diagnostic and prognostic significance of the absence of simple partial seizures (SPS) immediately preceding complex partial seizures (CPS) was examined in patients with temporal lobe epilepsy. The status of self-reported SPS in 193 patients with temporal lobe epilepsy who had surgical therapy more than 2 years ago was reviewed. Before surgery, 37 patients never experienced SPS before CPS (Group A), 156 patients either always or occasionally had SPS before CPS (Group B). The frequency of mesial temporal sclerosis (MTS) was lower and the age at onset of epilepsy was higher in Group A. The seizure focus was in the language-dominant temporal lobe in 73% of the cases in Group A, compared with 40% in Group B. The surgical outcome did not differ between the two groups. The findings suggest that temporal lobe seizures without preceding SPS tend to originate in the language-dominant temporal lobe that contains a pathologic etiology other than MTS, especially in the lateral temporal lobe. The surgical outcome in patients without SPS is similar to that in patients with SPS.     

Randomized controlled trial of zonisamide for the treatment of refractory partial-onset seizures.

BACKGROUND: Zonisamide is a sulfonamide antiepilepsy drug with sodium and calcium channel-blocking actions. Experience in Japan and a previous European double-blind study have demonstrated its efficacy against partial-onset seizures. METHODS: A randomized, double-blind, placebo-controlled trial enrolling 203 patients was conducted at 20 United States sites to assess zonisamide efficacy and dose response as adjunctive therapy for refractory partial-onset seizures. Zonisamide dosages were elevated by 100 mg/d each week. The study design allowed parallel comparisons with placebo for three dosages and a final crossover to 400 mg/d of zonisamide for all patients. The primary efficacy comparison was change in seizure frequency from a 4-week placebo baseline to weeks 8 through 12 on blinded therapy. RESULTS: At 400 mg/d, zonisamide reduced the median frequency of all seizures by 40.5% from baseline, compared with a 9% reduction (p = 0.0009) with placebo treatment, and produced a > or =50% seizure reduction (responder rate) in 42% of patients. A dosage of 100 mg/d produced a 20.5% reduction in median seizure frequency (p = 0.038 compared with placebo) and a dosage of 200 mg/d produced a 24.7% reduction in median seizure frequency (p = 0.004 compared with placebo). Dropouts from adverse events (10%) did not differ from placebo (8.2%, NS). The only adverse event differing significantly from placebo was weight loss, though somnolence, anorexia, and ataxia were slightly more common with zonisamide treatment. Serum zonisamide concentrations rose with increasing dose. CONCLUSION: Zonisamide is effective and well tolerated as an adjunctive agent for refractory partial-onset seizures. The minimal effective dosage was 100 mg/d, but 400 mg/d was the most effective dosage.     

奥卡西平治疗癫部分性发作50例疗效观察

目的观察奥卡西平治疗癫部分发作的疗效及安全性。方法 50例部分发作的癫患者采用奥卡西平治疗。成年患者的起始剂量为300mg/d。根据病情逐渐加量,3d后增至基本维持量600mg/d,仍有发作者继续加量,2周后达最佳效果或可耐受的最高剂量1 800mg/d;儿童患者起始剂量8～10mg/(kg.d),根据病情每周增加1次剂量,每次加量在10mg/(kg.d)以下,直至维持量30～40mg/(kg.d)。观察治疗后癫发作情况及药物不良反应。结果奥卡西平治疗5个月后,本组总有效率67.3%,完全控制率24.5%。用药1月内,本组10例患者出现不良反应,1例因剥脱性皮炎而停用此药。结论奥卡西平治疗癫部分性发作疗效较好,但有时可能产生严重的不良反应,临床应用时应谨慎。     

Variation of seizure frequency with ovulatory status of menstrual cycles

Purpose: To determine if seizure frequency differs between anovulatory and ovulatory cycles. Methods: The data came from the 3‐month baseline phase of an investigation of progesterone therapy for intractable focal onset seizures. Of 462 women who enrolled, 281 completed the 3‐month baseline phase and 92 had both anovulatory and ovulatory cycles during the baseline phase. Midluteal progesterone levels ≥5 ng/ml were used to designate cycles as ovulatory. Among the 92 women, average daily seizure frequency (ADSF) for all seizures combined and each type of seizure considered separately (secondary generalized tonic–clonic seizures – 2°GTCS, complex partial seizures – CPS, simple partial seizures – SPS) were compared between anovulatory and ovulatory cycles using paired t‐tests. A relationship between the proportional differences in ADSF and estradiol/progesterone (EP) serum level ratios between anovulatory and ovulatory cycles was determined using bivariate correlational analysis. Key Findings: ADSF was 29.5% greater for 2°GTCS during anovulatory than during ovulatory cycles. ADSF did not differ significantly for CPS or SPS or for all seizures combined. Proportional differences in anovulatory/ovulatory 2°GTCS ADSF ratios correlated significantly with differences in anovulatory/ovulatory EP ratios. Among the 281 women, the three seizure types did not differ in ovulatory rates, but EP ratios were greater for cycles with 2°GTCS than partial seizures only. Significance: Seizure frequency is significantly greater for 2°GTCS, but not CPS or SPS, during anovulatory cycles than ovulatory cycles. Because the proportional increases in 2°GTCS frequency during anovulatory cycles correlate with the proportional increases in EP level ratios, these findings support a possible role for reproductive steroids in 2°GTCS occurrence.     

Valproate Monotherapy in 30 Patients with Partial Seizures

This retrospective pilot study describes 30 patients diagnosed and treated for complex partial seizures (CPS) and simple partial seizures (SPS) with and without generalization who received valproate (VPA) monotherapy after lack of response or allergic reaction for carbamazepine (CBZ), phenytoin (PHT), or phenobarbital (PB). Seizures were tabulated daily on seizure calendars by the patients. Three time periods were examined for seizure frequency, 90 days before VPA treatment and 90 and 180 days after VPA treatment. Twenty-two were "controlled" or "improved" (reduction of seizure activity by greater than or equal to 51%) 6 months following the initiation of VPA. VPA was particularly effective in 17 patients who had secondarily generalized tonic-clonic seizures (GTCS) as a subtype of partial seizures. Failure of response to VPA in eight patients appears to be related to their type of partial seizure (SPS or CPS alone, without GTCS) and duration of uncontrolled recurrent seizures. Etiology and compliance were not related to treatment failure. This study supports the need for a double-blind controlled trial with VPA in patients with partial seizures.     

Significance of Simple Partial Seizures in Temporal Lobe Epilepsy

Summary: We determined how localization of simple partial seizures (SPS) correlated with localization of complex partial seizure (CPS) in scalp/sphenoidal EEG and assessed prognosis after temporal lobe resective surgery in patients with an ictal correlate of SPS in scalp/sphenoidal EEG recordings. EEGs were recorded with the 10–20 system of electrode placement and supplemented with sphenoidal electrodes. Between 1985 and 1992, 183 patients with temporal lobe epilepsy (TLE) reported an aura (SPS) during inpatient monitoring; all were eligible for inclusion in our study. The EEGs during SPS showed ictal changes in 51 patients (28%, 117 SPS). Forty-four patients had unilateral temporal interictal spikes (IIS), and SPS and CPS always arose from the same region. Seven patients had bitemporal interictal spikes; SPS colocalized with CPS in 4 patients (57%), SPS were contralateral to CPS in 2 patients, and 1 patient had bilateral independent CPS but unilateral SPS. SPS accompanied by EEG ictal changes conveyed a favorable prognosis in patients who underwent epilepsy surgery. Scalp/sphenoidal recorded IIS but were less reliable in identifying the location of CPS onset in patients with bitemporal spikes.     

Topiramat (Topamax®) Pharmakologische Charakteristik und Stellenwert in der aktuellen Epilepsietherapie

Topiramate (Topamax) has been registered since July 1998 and has market authorization for the Federal Republic of Germany as an additive drug for the treatment of patients (age 12 or older) suffering from intractable partial and secondarily generalized seizures. The anticonvulsant effect of topiramate is based on three mechanisms: (a) modulating the blocking of the Na channels activated by voltage, depending on status, (b) potentiation of GABAA-mediated inhibiting neurotransmission, and (c) inhibition of excitatory neurotransmission by blocking APMA glutamate receptors. Topiramate exhibits a substantial anticonvulsive effect on partial seizures both with and without secondary generalization. The median reduction in seizure frequency using topiramate as adjunct therapy was 44%. In 44% of patients, seizure frequency was reduced by more than 50%, and seizure reduction was more than 75% in nearly half of these (i.e., in 21% of all patients), while 5% of patients remained completely free of seizures. Adverse events most often caused central nervous disturbances. Weight loss, the development of renal calculi, and impairment of cognitive functions may occur. It is recommended to start therapy with topiramate at a daily dosage of 25 mg, increasing by 25 mg every week up to 200-400 mg/day but not exceeding 1000 mg/day.