60例癫痫患者治疗的疗效分析

目的比较丙戊酸钠与左乙拉西坦治疗癫痫的疗效。方法将60例癫痫患者完全随机分为丙戊酸钠组30例,左乙拉西坦组30例。丙戊酸钠组应用丙戊酸钠治疗,左乙拉西坦组应用左乙拉西坦治疗,观察治疗效果。结果丙戊酸钠组30例癫痫患者治疗后无效4例、有效20例、完全控制5例、加重1例、总有效率25例(83.4%);左乙拉西坦组30例癫痫患者治疗后无效3例、有效18例、完全控制6例、加重3例、总有效率24例(80%)。两组总有效率的比较差异无统计学意义,即总有效率差异无显著性。结论丙戊酸钠和左乙拉西坦均是相对有效的抗癫痫治疗药物。     

脑卒中后癫痫的临床治疗及效果研究

目的:研究分析脑卒中后癫痫的临床治疗效果.方法:抽取入本院治疗的70例脑卒中后癫痫患者作为研究对象,研究时间为2015年7月～2016年12月,用随机数字表法分配患者,分为观察组和对照组,每组35例,观察组和对照组分别采用丙戊酸钠、左乙拉西坦进行治疗,对比观察组与对照组的治疗效果,主要对比指标为癫痫发作次数、持续时间.结果:治疗后,观察组癫痫发作次数、持续时间均低于对照组,治疗有效率比对照组高,差异有统计学意义(P<0.05).结论:丙戊酸钠治疗脑卒中后癫痫的效果较好,具有较高的临床应用价值.     

一种独特的新抗癫痫药——左乙拉西坦

左乙拉西坦(Levetiracetam,LEV)是最新上市的新一代抗癫痫药,其结构式及机制不同于其他抗癫痫药,具有较为理想的药代动力学。临床研究表明对难治性癫痫的有效率为30％～50％,对各类型癫痫均有较好的疗效。单药治疗亦有效。成人推荐剂量为1 000～3 000mg/d。常见的不良反应有头痛、嗜睡、乏力、眩晕、情绪不稳、人格障碍等,出现率在25％以下。对认知障碍影响的出现率<6% 。不良反应均为轻～中度。     

抗癫痫药物与癫痫恶化

近 2 0年来 ,许多资料显示抗癫药物 (ＡＥＤｓ)会使癫恶化 ,即原有类型癫发作增多 ,或激发新的癫类型。临床上可见以下 4种情况 :①非特异性的药物中毒表现 :即患儿仅出现癫发作加重 ,而无其他中毒表现 ,减少剂量或取消不必要的多药治疗后就可好转。②药物选择失误。③药物副作用。④抗癫药物引起的脑病和多种类型混合发作的儿童癫性脑病[1] 。1　药物过量早已报道苯妥英钠 (ＰＨＴ)中毒量可致癫恶化。国内报道ＰＨＴ致癫恶化发生率 8.6% [2 ] 。Ｄｈａｎａ报道 4例卡马西平(ＣＢＺ)中毒的患者中 ,有 1例出现一系列全身性…     

左乙拉西坦治疗儿童癫 的疗效及对认知功能影响简

目的 观察左乙拉西坦治疗儿童部分性发作癫痫的临床疗效及对认知功能的影响.方法 选取80例癫痫患儿,随机分为治疗组和对照组各40例,治疗组采用左乙拉西坦片治疗,po,起始剂量5 mg.kg^-1.d^-1,以后每周加量5 mg.kg^-1.d^-1,直至最小有效剂量维持,最大剂量不超过50 mg.kg^-1.d^-1.对照组采用丙戊酸钠片治疗,开始10～15 mg.kg^-1.d^-1,每周增加10 mg.kg^-1.d^-1,直至有效剂量维持,最大不超过60 mg.kg^-1.d^-1.通过治疗前后症状,脑电图及韦氏儿童智力量表(WISC)的变化评价两种药物的临床疗效以及对认知功能的影响.结果 治疗组中37例患儿完成治疗,癫痫症状完全控制28例(75.7%),好转6例(16.2%),无效3例(8.1%);对照组中38例患儿完成治疗,癫痫症状完全控制25例(65.8%),好转8例(21.0%),无效5例(13.2%);治疗组控制症状的总有效率稍高于对照组,但差异无统计学意义(P>0.05).治疗组脑电图总有效率为91.9%,对照组为68.4%,差异有统计学意义(P<0.05).治疗结束后对照组患儿操作智商(PIQ)评分显著低于治疗组(P<0.05),而言语智商(VIQ),总智商(FIQ)差异无统计学意义.两组患儿治疗期间不良反应发生率差异无统计学意义(P>0.05).结论 左乙拉西坦治疗部分性发作癫痫患儿具有与丙戊酸钠相似的疗效,对脑电图改善总有效率显著高于丙戊酸钠,对认知功能无明显影响,不良反应以心理状态改变为主,临床使用安全性较高.     

左乙拉西坦联合丙戊酸钠治疗癫痫的效果及对神经递质、血清miR-222、miR-542-3p水平的影响

目的：研究左乙拉西坦联合丙戊酸钠对癫痫患者疗效及癫痫发作次数、神经递质、血清微小RNA-222(miR-222)、微小RNA-542-3p(miR-542-3p)水平的影响。方法：选取2019年10月—2021年10月某院收治的180例癫痫患者为研究对象,采用随机数字表法分为A组和B组,每组90例。B组采用丙戊酸钠治疗,A组采用左乙拉西坦联合丙戊酸钠治疗。比较2组临床疗效、治疗前、治疗6个月后癫痫发作次数、持续时间、血清神经递质水平[神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)、脑源性神经营养因子(BDNF)]、血清白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、miR-222、miR-542-3p水平、不良反应发生率。结果：A组临床总有效率(94.44%)高于B组(83.33%)。治疗6个月后,A组癫痫发作次数[(1.12±0.26)次/月]少于B组[(2.29±0.38)次/月],发作持续时间[(1.98±0.55)分/次]短于B组[(3.14±0.61)分/次],血清NSE[(31.41±5.21)μg/L]、GFAP[(1.37±0.36)ng/mL]水...     

不同药物(丙戊酸钠、左乙拉西坦)治疗小儿癫痫的效果对比

目的:关于丙戊酸钠、左乙拉西坦治疗小儿癫痫的疗效评价分析.方法:取2015年3~11月于我院应用左乙拉西坦治疗小儿癫痫的32例患者为本次研究对照组,另取次年同期在我院应用丙戊酸钠治疗的35例小儿癫痫患者作为本次研究观察组,将两组治疗效果加以比较.结果:观察组85.7%治疗有效率与对照组71.9%治疗有效率相比,优势显著(P<0.05).结论:丙戊酸钠是治疗小儿癫痫的理想药物,两种药物均有一定抗癫痫效果,但相比较而言,丙戊酸钠在临床治疗效果更具优势.     

丙戊酸钠对难治性癫痫患者神经因子及炎性因子水平的影响

目的 观察丙戊酸钠对难治性癫痫患者神经因子及炎性因子水平的影响。方法 选取2019年1月—2022年6月福州市第一医院收治的难治性癫痫患者83例,采用随机数字表法分为丙戊酸钠组(n=42)和左乙拉西坦组(n=41)。在常规对症支持治疗基础上,左乙拉西坦组患者给予左乙拉西坦治疗,丙戊酸钠组患者给予丙戊酸钠治疗,2组均持续治疗6个月。比较2组患者的临床疗效,治疗前及治疗2、4、6个月后的认知状态及神经功能缺损程度,治疗前后的神经因子、炎性因子水平及不良反应。结果 丙戊酸钠组患者治疗总有效率为97.62%,高于左乙拉西坦组的78.05%(χ²=7.499,P=0.006)。丙戊酸钠组患者治疗4、6个月后的简易智能精神状态表(MMSE)评分均高于左乙拉西坦组(P<0.01);丙戊酸钠组患者治疗6个月后神经功能缺损评分(NIHSS)低于左乙拉西坦组(P<0.01)。治疗6个月后,2组患者神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)水平和肿瘤坏死因子-α(TNF-α)、白介素-2(IL-2)、白介素-6(IL-6)水平均较治疗前降低,且丙戊酸钠组低于左乙...     

左乙拉西坦与丙戊酸钠治疗儿童癫痫疗效对比

目的 探讨左乙拉西坦与丙戊酸钠对癫痫患儿临床发作的控制和脑电图痫样放电改善的对比.方法 将122例癫痫患儿随机分为观察组(左乙拉西坦组)和对照组(丙戊酸钠组).对照组与观察组患儿分别予丙戊酸钠、左乙拉西坦治疗.随访半年,记录期间癫痫发作次数;两组患儿分别于治疗前和治疗半年后行动态脑电图监测.结果 左乙拉西坦组脑电图痫样...     

丙戊酸钠与左乙拉西坦治疗卒中后癫痫的疗效比较

目的：比较丙戊酸钠与左乙拉西坦治疗卒中后癫痫的临床疗效和安全性。方法将92例卒中后癫痫的患者按照随机、自愿的原则分为对照组和研究组各46例。所有患者均给予常规治疗,对照组在常规治疗基础上加用左乙拉西坦治疗,研究组在常规治疗基础上加用丙戊酸钠治疗。比较2组患者治疗后的临床效果和用药期间不良反应发生情况。结果丙戊酸钠组患者总有效率93.4%明显高于左乙拉西坦组的78.2%,差异有统计学意义（P ﹤0.05）。2组患者治疗期间均未发生明显不良反应。结论丙戊酸钠治疗卒中后癫痫的临床效果优于左乙拉西坦,且安全性好,值得在临床中推广应用。     

Therapeutic monitoring of the new antiepileptic drugs

Objective: To discuss the potential value of therapeutic drug monitoring (TDM) of the new antiepileptic drugs gabapentin, lamotrigine, oxcarbazepine, tiagabine, topiramate, vigabatrin and zonisamide. Methods: A review of studies of the relationship between plasma concentrations and effects of new antiepileptic drugs is provided. Furthermore, the potential value of TDM of these drugs is discussed in relation to their mode of action and their pharmacokinetic properties. The various methods that are available for analysing plasma concentrations of the new antiepileptic drugs are also briefly reviewed. Results: The available information on the relationship between plasma concentrations and effects of the new drugs is scarce. For most drugs, wide ranges in concentrations associated with seizure control are reported, and a considerable overlap with drug levels among non-responders and also with concentrations associated with toxicity is often noted. However, very few studies have been designed primarily to explore the relationship between drug plasma concentrations and effects. Consequently, there are no generally accepted target ranges for any of the new antiepileptic drugs. Although the available documentation clearly is insufficient, the pharmacological properties of some of the drugs, in particular lamotrigine, zonisamide and, possibly, oxcarbazepine, topiramate and tiagabine, suggest that they may be suitable candidates for TDM. Conclusion: TDM of some of the new antiepileptic drugs may be of value in selected cases, although routine monitoring in general cannot be recommended at this stage. Further systematic studies designed specifically to investigate concentration–effect relationships of the new antiepileptic drugs are urgently needed. Received: 16 September 1999 / Accepted in revised form: 9 October 1999     

Use and safety profile of antiepileptic drugs in Italy

Objective To analyse and discuss the use and the safety profile of individual antiepileptic drugs (AEDs) in Italy. Methods The AED safety data referred to the period January 1988–June 2005 and were obtained from the database of the Italian Interregional Group of Pharmacovigilance (GIF). This database collects all spontaneous reports of suspected adverse drug reactions (ADRs) from six Italian regions which are the main contributors to the Italian spontaneous reporting system. Individual AED consumption data (defined daily dose/1,000 inhabitants per day) in the GIF area and in the whole of Italy referred to the period January 2003-June 2005 and were derived from drug sales data (Institute for Medical Statistics Health). Results Phenobarbital was the most frequently used AED in the GIF area (4.26 DDD/1,000 inhabitants per day) followed by carbamazepine (1.97), valproic acid (1.33) and gabapentin (1.10). AED consumption in the whole of Italy showed a similar pattern. Gabapentin was the most frequently used AED among newer AEDs. In the GIF database 37,906 reports (up to June 2005) were present; 666 of them (1.76%) were associated with at least one AED (Anatomical Therapeutic Chemical code N03A). The AED with the highest number of reports was carbamazepine (208 reports) followed by phenobarbital (98), gabapentin (80), phenytoin (56), valproic acid (55), lamotrigine (51), oxcarbazepine (43) and vigabatrin (35). Use and toxicity profile were evaluated only for AEDs associated with at least 30 reports. Skin reactions were the most frequently reported ADRs, followed by haematological, general condition, hepatic, neurological and gastrointestinal adverse reactions. Phenobarbital, lamotrigine, carbamazepine and phenytoin had the highest percentage of skin reactions (69, 67, 60 and 54%, respectively). Many haematological reactions were reported for each AED; the highest percentage was related to valproic acid (25%). Vigabatrin was associated with the highest percentage of reactions related to hearing, vision and other senses (97%). Phenytoin and valproic acid had the highest percentage of hepatic reactions (30 and 20%), whereas gabapentin of nervous system, psychiatric, gastrointestinal and urinary reactions (26, 21, 21 and 14%, respectively) and phenobarbital of musculoskeletal reactions (13%). Conclusions In Italy antiepileptic drug therapy appears to be still dominated by traditional drugs. Our analysis showed a different safety profile related to each AED. Some of the drug-adverse reaction associations discussed are not included in the Italian drug leaflets or have not been reported before in the literature.     

应用不同抗癫痫药治疗儿童癫痫与肥胖的关系

目的　了解应用不同抗癫痫药 (AEDs)所导致癫痫患儿肥胖的情况。方法　根据患儿服用的不同AEDs,将 6 6例癫痫病人分为丙戊酸钠治疗组和非丙戊酸钠治疗组两组 ,对其体重 (Wt)及身高 (H)从服用AEDs开始进行为期 6个月的观察 ,观察肥胖指标 (BMI)的变化情况。结果　丙戊酸钠治疗组从治疗后 3个月开始出现肥胖 ,到治疗后 6个月时 ,男、女性的肥胖指标才有统计学的差异 ;丙戊酸钠治疗组的肥胖指标与非丙戊酸钠治疗组的统计学差异 ,也是从治疗后 3个月开始。结论　应用丙戊酸钠后可导致癫痫病人出现肥胖 ,其肥胖发生的时间一般在开始应用此药治疗后 3个月 ,因此 ,临床上应用丙戊酸钠时 ,要注意导致癫痫病人出现肥胖的问题。     

Effects of etomidate,ketamine or propofol,and their combinations with conventional antiepileptic drugs on amygdala-kindled convulsions in rats

Ketamine, etomidate and propofol modified behavioral and electrographic correlates of kindled seizures in rats. In detail, ketamine (5 mg/kg) and propofol (15 mg/kg) significantly increased afterdischarge threshold, reduced seizure severity and shortened seizure and afterdischarge durations. Etomidate (7.5 mg/kg) was effective in terms of seizure and afterdischarge durations. Moreover, the combinations of ketamine (2.5 mg/kg) with carbamazepine (15 mg/kg) or valproate (50 mg/kg; all drugs at their subeffective doses), reduced the severity and duration of kindled seizures. The antiseizure potency of the ketamine/carbamazepine combination was comparable to that of carbamazepine alone administered at 20 mg/kg, while the effect of ketamine/valproate was comparable to the efficacy of valproate alone at 100 mg/kg. However, the combinations of ketamine with phenobarbital or diphenylhydantoin did not exert any protective action. Propofol and etomidate entirely failed to interact with conventional antiepileptics. The combinations of ketamine with carbamazepine or valproate did not induce any significant motor impairment in the chimney test or memory deficit in the passive avoidance task. A pharmacokinetic interaction, at least in plasma, can be excluded, because ketamine (2.5 mg/kg) did not affect the free plasma concentrations of carbamazepine or valproate. Results of the present study may suggest that there may be no risk of negative interactions between injectable anesthetics and antiepileptics in cases of partial epilepsy.     

Markers of bone turnover in patients with epilepsy and their relationship to management of bone diseases induced by antiepileptic drugs

Data from cross-sectional and prospective studies revealed that patients with epilepsy and on long-term treatment with antiepileptic drugs (AEDs) are at increased risk for metabolic bone diseases. Bone diseases were reported in about 50% of patients on AEDs. Low bone mineral density, osteopenia/osteoporosis, osteomalacia, rickets, altered concentration of bone turnover markers and fractures were reported with phenobarbital, phenytoin, carbamazepine, valproate, oxcarbazepine and lamotrigine. The mechanisms for AEDs–induced bone diseases are heterogeneous and include hypovitaminosis D, hypocalcemia and direct acceleration of bone loss and/or reduction of bone formation. This article reviews the evidence, predictors and mechanisms of AEDs-induced bone abnormalities and its clinical implications. For patients on AEDs, regular monitoring of bone health is recommended. Prophylactic administration of calcium and vitamin D is recommended for all patients. Treatment doses of calcium and vitamin D and even anti-resorptive drug therapy are reserved for patients at high risk of pathological fracture.     

Acute and chronic treatment with mianserin differentially affects the anticonvulsant activity of conventional antiepileptic drugs in the mouse maximal electroshock model

Rationale Epilepsy often coexists with depression. Therefore, the probability of simultaneous treatment with antiepileptics and antidepressants and the possibility of interactions between them are relatively high. Objective The effects of acute and chronic administration of mianserin on the protective activity of valproate (VPA), carbamazepine, phenytoin, and phenobarbital were evaluated in the maximal electroshock in mice. Materials and methods Animals were subjected to electroconvulsions. Undesired effects were evaluated in the chimney test (motor impairment) and passive-avoidance task (memory deficit). Brain concentrations of antiepileptic drugs were assessed by immunofluorescence. Results When given acutely, mianserin (at doses greater than or equal to 20 mg/kg) significantly raised the electroconvulsive threshold. The antidepressant, at the subanticonvulsant doses, enhanced the anticonvulsant action of carbamazepine, phenytoin, and VPA. Mianserin administered chronically at 30 mg/kg significantly decreased the electroconvulsive threshold. In contrast to acute treatment, the antidepressant at subeffective doses diminished the anticonvulsant activity of VPA and phenytoin. Mianserin given either acutely or chronically did not affect the brain concentrations of antiepileptic drugs, so a pharmacokinetic contribution to the observed interactions is not probable. Acute and chronic treatment with mianserin and its combinations with antiepileptic drugs did not impair either motor coordination or long-term memory. Conclusion Although acute application of mianserin may potentiate the anticonvulsant action of some antiepileptics, its chronic administration can lead to the opposite effect. Therefore, as far as the presented results can be transferred to clinical conditions, the antidepressant therapy with mianserin should be limited or even avoided in epileptic patients.     

Pregnancy outcome in women exposed to antiepileptic drugs: Teratogenic role of maternal epilepsy and its pharmacologic treatment

Infants born to epileptic women treated with antiepileptic drugs (AEDs) have an increased risk of major congenital malformations (MCMs).In order to determine the role of maternal epilepsy we conducted a prospective cohort study on three cohorts of pregnant women: (i) 385 epileptic women treated with AEDs, (ii) 310 non-epileptic women treated with AEDs, (iii) 867 healthy women not exposed to AEDs (control group). The rate of MCMs in the epileptic group (7.7%) was not statistically higher than in the non-epileptic one (3.9%) (p = 0.068). The rate in the first group was higher compared to the control group (p = 0.001), while the rate in the second one was not (p = 0.534).Our data confirm that AEDs therapy is the main cause of the increased risk of malformations in the offspring of epileptic women; however a teratogenic role of the maternal epilepsy itself cannot be excluded.     

三种常用抗癫痫药物对儿童注意力的影响

目的 :了解苯巴比妥、卡马西平、丙戊酸钠对癫痫患儿注意力的影响。方法 :4 5例患儿随机分组服用这三种药物 ,分别在服药前及服药后 6个月、1年、2年时用NJ2 2型注意力测试仪测试患儿的注意力 ,比较服药前后及三种药物间的注意力缺陷值变化。结果 :三组患儿服药后 6个月、1年、2年后注意力缺陷值改变不显著 (P >0 0 5 ) ,三种药物间注意力缺陷值比较无显著差异 (P >0 0 5 )。结论 :三种药物单药常规剂量时对患儿注意力没有明显的不良影响     

Safety and tolerability profile of new antiepileptic drug treatment in children with epilepsy

Introduction: Treatment of pediatric epilepsy requires a careful evaluation of the safety and tolerability profile of antiepileptic drugs (AEDs) to avoid or minimize as much as possible adverse events (AEs) on various organs, hematological parameters, and growth, pubertal, motor, cognitive and behavioral development.

Areas covered: Treatment-emergent AEs (TEAEs) reported in the literature 2000–2018 regarding second- and third-generation AEDs used in the pediatric age, with exclusion of the neonatal period that exhibits specific peculiarities, have been described on the basis of their frequency, severity/tolerability, and particular association with a given AED.

Expert opinion: Somnolence/sedation and behavioral changes, like irritability and nervousness, are among the most commonly observed TEAEs associated with almost all AEDs. Lamotrigine, Gabapentin, Oxcarbazepine, and Levetiracetam appear to be the best-tolerated AEDs with a ≤2% withdrawal rate, while Tiagabine and Everolimus are discontinued in up to >20% of the patients because of intolerable TEAEs. For some AEDs, literature data are scanty to draw a high-level evidence on their safety and tolerability profile. The reasons are: insufficient population size, short duration of treatments, or lack of controlled trials. A future goal is that of identifying clearer, easier, and more homogeneous methodological strategies to facilitate AED testing in pediatric populations.     

丙戊酸托吡酯治疗儿童特发性全身性癫痫疗效比较研究

目的：评价丙戊酸和托吡酯治疗儿童特发性全身性癫痫的疗效及耐受性。方法：对1999年10月至2003年4月来我院的152例首诊特发性全身性癫痫并接受丙戊酸或/和托吡酯治疗的病人进行随访。并对结果进行分析。结果：丙戊酸单药治疗完全控制率为63．41％。托吡酯单药治疗完全控制率40．00％,二者有显著差异;丙戊酸部分控制者添加托吡酯治疗31．25％完全控制,托吡酯治疗部分控制者添加丙戊酸后36．84％发作停止。无显著差异。两种药物的不良反应均较轻且耐受性较好。结论：丙戊酸是治疗儿童特发性全身性癫痫的最有效药物之一。如丙戊酸未能完全控制发作。添加托吡酯治疗疗效好。