托吡酯治疗儿童偏头痛的疗效观察

目的 观察托吡酯治疗儿童偏头痛的临床效果。方法 选取我院门诊收治的偏头痛患儿作为研究对象,分别采用托吡酯和氟桂利嗪治疗,2组患儿均治疗3个月,观察治疗效果。结果 观察组治疗后每月偏头痛发作次数及发作持续时间分别为(0.89±0.43)次、(0.76±0.41)d,均少于对照组,差异具有统计学意义(P<0.05);观察组总有效率显著性高于对照组(χ2=4.24,P<0.05)。结论 托吡酯治疗儿童偏头痛效果显著,头痛发作次数和发作持续时间均有所减少,值得临床推广应用。     

托吡酯辅助治疗儿童多动症的临床对照观察

目的：探讨托吡酯辅助治疗伴脑电图不正常的儿童多动症的可行性。方法：对37例伴脑电图不正常的儿童多动症患者分别应用托吡酯 利他林与利他林进行对照比较；采用Achenbach儿童行为量表（由家长评），Conners多动指数（由老师评），临床疗效总评量表（CGI）及治疗时出现的症状量表（TESS）等评定。结果：两组治疗前后的量表评定均有显著性差异；两组间比较有统计学差异；治疗前后减分率Achenbach儿童行为量表托吡酯组为62.81%，利他林组为53.96%，多动指数量表托吡酯组为65.65%，利他林组为51.32%，两组间比较均有统计学差异。不良反应发生率低，TESS量表两组比较无差异。结论：托吡酯辅助治疗伴脑电图不正常的儿童多动症患者有临床疗效，值得进一步探讨。     

托吡酯长期治疗儿童癫痫部分性发作疗效及耐受性的观察

目的观察托吡酯长期治疗儿童癫(癎)部分性发作的疗效、耐受性及安全性.方法对86例癫(癎)部分性发作的患儿给予托吡酯加用或单药治疗,起始剂量为0.5～1.0 mg/(kg·d),分2次口服,每周增加0.5～1.0 mg/(kg·d),经过8周加量期及18个月稳定期,观察其疗效、耐受性及安全性.结果 86例患儿完成加量期后,总有效率为61.6%,控制率为37.2%.稳定期6、12及18个月时总有效率分别为68.6%、81.9%及86.4%,控制率分别为46.5%、59.0%及60.5%,稳定期12及18个月时总有效率及控制率与加量期比较差异有显著性(均P<0.05).不良反应多发生在治疗初期,为一过性轻～中度嗜睡、厌食等.在稳定期18个月时仍有78例(90.7%)坚持服用托吡酯.结论托吡酯对儿童癫(癎)部分性发作的长期治疗,具有较高的疗效及较好的安全性与耐受性.     

托吡酯治疗难治性癫痫的疗效观察

目的：临床临床观察托吡酯（TPM）对难治性癫的疗效和安全性。方法：观察总结21例难治性癫痫病人，在原来应用抗癫痫药物（AEDs）种类及剂量不变的基础上，另增添TPM后3个月与治疗前1个月，癫痫发作频度进行个体自身比较。结果：完全被控制率38．1％，好转率33．3％，总有效率71．4％，不良反应轻微。结论：TPM治疗各类难治性癫痫的疗效显著，安全性好。     

托吡酯治疗儿童原发性全身强直阵挛性癫痫长期临床疗效的研究

目的 采用不同剂量的托吡酯治疗27例儿童原发性全身强直阵挛性癫痫(GTCS)的长期开放性研究。方法 TPM治疗的平均时间为520±190 d(范围235～660 d),TPM经加量期和稳定期后继续治疗3个月和6个月的平均剂量为4.13 mg╱(dg·d)。结果 在最后观察中,GTCS发作频率减少率约80％。接受不同剂量TPM(<4mg╱(kg·d),4～8mg╱(kg·d),>8mg╱(kg·d)的治疗反应大致相同(P>O.05)。而最常见的不良反应为中枢神经系统的表现。经过2年的治疗,仅2例(7.4％)患儿因不良反应和发作未得到适当的控制而未继续用药。结论 TPM在长期开放性治疗儿童原发性全身强直阵挛性癫痫具有良好的耐受性和安全性,尤可用于不能明确区分或分类的癫痫综合征。TPM可作为基础抗癫痫药物失败后长期控制GTCS的广谱的抗癫痫药。     

托吡酯和普萘洛尔预防儿童偏头痛的临床疗效观察

目的 比较和评价托吡酯和普萘洛尔在儿童偏头痛预防中的临床疗效。方法 采用随机、对照、前瞻性的研究方法,共纳入了93例5～17岁的偏头痛患儿进行研究。将患儿随机分为两组,其中A组46例给予托吡酯50mg·d^-1治疗,B组47例给予普萘洛尔1 mg·kg^-1·d^-1治疗,持续观察3个月。分别记录患儿的在治疗后第1个月,第2个月及第3个月头痛发作次数、严重程度、持续时间及不良反应。结果治疗3个月后,托吡酯组和普萘洛尔组患儿的头痛发作频率、严重程度和持续时间均较用药前显著降低,在治疗的第2个月和第3个月,托吡酯每月头痛发作频率及持续时间较普萘洛尔下降更显著(P<0.05);在治疗的第3个月,托吡酯组患儿的头痛严重程度(VAS评分)低于普萘洛尔组(P<0.05)。两组均未出现严重不良反应。结论 托吡酯和普萘洛尔均能有效的减少儿童偏头痛发作频率,严重程度及持续时间;且托吡酯比普萘洛尔效果更为显著。两种药物的安全性良好。     

托吡酯治疗难治性癫痫的疗效观察

目的 评价托吡酯（TMP）添加治疗难治性癫痫的疗效和其不良反应，以及对原服用AEDs血中浓度的影响。方法 采用开放性试验的方法对80例难治性癫痫进行添加托吡酯治疗，观察其疗效。结果 托吡酯作为添加治疗难治性癫痫总有效率58.6%。对单纯部分性发作有效率66.7%。复杂部分性发作25%，且完全控制率12.9%，不良反应均与CNS有关，多为一过性，但儿童的无汗，体重减轻，持续时间长，原服用AEDs血中浓度在添加托吡酯前后无明显变化。结论 托吡酯治疗难治性癫痫有效，但要注意用药量的个体化。     

托吡酯治疗难治性癫痫的疗效观察

目的　评价托吡酯 (TPM)单药治疗难治性癫痫 (IE)的疗效及其不良反应。方法　选择 5 6例各种类型发作的 IE患者给予 TPM单药治疗 ,前 8周为调整期 ,后 8周为稳定期 ,总观察期 16周。每 2周观察 1次 ,疗效评估每 4周 1次。并对不同时期 TPM剂量与癫痫发作次数作相关分析以及观察不良反应。结果　 5 6例患者 (15例因多种原因中途退出者不含在内 ) TPM剂量 2 41.6 7± 75 .6 6 m g/ d(15 0～ 6 0 0 m g/ d)。调整期随着 TPM剂量增加患者癫痫发作频率逐渐减少 ,呈显著相关性 (r=0 .6 32 7,P<0 .0 0 0 1) ;稳定期 TPM剂量不增加而患者癫痫发作次数继续减少 ,相关性呈现下降趋势 (r=0 .5 92 1,P<0 .0 0 1;r=0 .40 44 ,P<0 .0 1)。全组有效率为 73.2 1% ,包括 6例完全不发作者。治疗初期 18例患者出现一过性轻度不良反应 ,治疗中未见病情恶化者。结论　托吡酯能有效减少难治性癫痫临床发作 ,较佳疗效时间窗在第 12～ 16周。     

托吡酯联合丙戊酸钠治疗儿童癫痫的有效性及安全性

目的探讨托吡酯联合丙戊酸钠治疗儿童癫痫的有效性及安全性。方法选取80例癫痫患儿,随机分为对照组和联合组各40例,对照组给予托吡酯单药治疗,联合组在对照组用药基础上加用丙戊酸钠治疗。观察2组疗效及不良反应发生情况。结果治疗3个月时联合组治疗总有效率95.00%高于对照组80.00%(P0.05),治疗6个月时2组治疗总有效率分别为97.50%、87.50%,差异无统计学意义(P0.05);治疗3、6个月时2组癫痫发作月均频率明显低于治疗前(P0.01),治疗6个月癫痫发作月均频率明显低于治疗3个月(P0.01),治疗3、6个月时联合组癫痫发作月均频率明显低于对照组(P0.01);对照组不良反应发生率10.00%,联合组为15.00%,差异无统计学意义(P0.05)。结论托吡酯联合丙戊酸钠治疗儿童癫痫可在短期内减少癫痫发作频率,未明显增加不良反应发生率,耐受性较好。     

不同药物联合治疗药物过度使用性头痛的疗效及安全性

目的观察药物过度使用性头痛(medication overuse headache,MOH)的临床特征及不同药物联合治疗MOH的疗效及安全性。方法对头痛门诊序贯就诊的480例偏头痛患者详细采集病史,筛选很可能的MOH患者,与周期性发作偏头痛患者比较其临床特征,并行偏头痛残疾程度评估问卷(migraine disabilityassessment questionnaire,MIDAS)调查。对所有MOH患者强烈建议停用各种止痛剂,随机分组分别给予盐酸氟桂利嗪+普萘洛尔(Ⅰ组)或托吡酯+阿米替林(Ⅱ组)治疗,疗程3个月。观察两组治疗转归及不良反应发生率。结果 46例为很可能的MOH。MOH组起病年龄与周期性偏头痛组无明显差异(30.2±9.3岁;31.1±9.5岁)(P>0.05)。MOH组头痛家族史比例(67.4%)稍高于周期性偏头痛组(54.9%)(P>0.05),MOH组服用复方止痛药及中重度残疾的比例均显著高于周期性偏头痛组(分别为89.1%与39.3%;76.1%与19.5%)(P均<0.001)。治疗3个月后,Ⅰ组与Ⅱ组服用止痛药的比例为10.5%与10.0%,每月头痛天数为(3.21±0.85)d与(3.05±0.83)d,MIDAS总分(19.70±7.00)与(18.30±6.77),不良反应发生率分别为10.5%(Ⅰ组)与10.0%(Ⅱ组),两组间均无统计学差异(P>0.05)。结论有头痛家族史长期频繁使用复方止痛剂更易导致MOH,造成残疾。撤用止痛剂,盐酸氟桂利嗪+普萘洛尔或托吡酯+阿米替林均可明显缓解症状,耐受性好,值得临床推广。     

Pharmacological and behavioral treatment of pediatric migraine and tension-type headache

The problem concerning the treatment of pediatric headache has been the object of several recent reports. Some of the same medications used to treat adult headache problems are also utilized with children but usually at smaller dosages and in different combinations. The recent application of behavioral approaches, in particular biofeedback, for treatment of children’s headaches has been an effective alternative to drugs without the problematic and dangerous side effects of pharmacological treatments. The purpose of this review is to give some indications about the most common pharmacological therapies for migraine and tension-type headache in children, and also to discuss the use of behavioral therapies, in particular biofeedback, as excellent alternatives to drugs.     

Emotional and behavioral problems in pediatric patients with migraine and tension-type headache

ObjectiveThis study aimed to investigate the associations between psychopathological characteristics of children and adolescents with primary headache, as measured by the Strengths and Difficulties Questionnaire (SDQ), and treatment outcomes.MethodsA cohort study was conducted on 124 pediatric patients with primary headache. At the first consultation, the SDQ was completed by the parents. The analysis of treatment efficacy was conducted on 90 patients with a follow-up period of at least one year. Treatment responders were defined as those who showed 50% reduction in the headache frequency. First, an analysis of the SDQ total scores and five subscales, among the migraine and tension-type headache groups, was conducted for 124 participants. Second, the association between the SDQ scores and treatment outcomes in the groups with periods of improvement of less than three months and three months or more were analyzed in 90 patients.ResultsMigraine patients displayed more difficulties than strengths in terms of the total score (p = .004) and in the emotional symptoms subscale (p = .012) compared with tension-type headache patients. Migraine patients who required more than three months to show improvement displayed more peer problems (p = .020), while tension-type headache patients who required more than three months to show improvement displayed fewer conduct problems (p = .007).ConclusionEvaluation of patient characteristics using the SDQ at first consultation can predict the treatment outcome. Moreover, it can help provide appropriate initial treatment and improve outcome of primary headache in children.     

Incidence of kidney stones with topiramate treatment in pediatric patients

Purpose: We ran this study to assess the incidence of nephrolithiasis in a group of children on topiramate (TPM) therapy for at least 1 year. Methods: In this retrospective observational surveillance study, we reviewed the medical charts of children on TPM for at least 1 year seen at the pediatric neurology department during the period from 2005 to 2010 at King Fahad Medical City. Children with a normal baseline ultrasound report were included. Follow‐up ultrasound reports after at least 1 year were collected. However, patients with any evidence of chronic illness or medications that may affect the kidney functions in addition to those who are not compliant with the prescribed dose were excluded. Family history of renal stones, symptoms suggestive of urologic disorders, and comorbidities were recorded. Key Findings: Medical charts of 96 children on TPM with a mean age of 6.9 (±3.8) years were reviewed; 52 (54.2%) of the children were male. The follow‐up ultrasound showed that five children (5.2%) had developed kidney stones. The occurrence of kidney stones was found in four female patients (80%) versus one male (20%) (p > 0.05). Significance: Long‐term use of TPM may result in increased incidence of asymptomatic kidney stones in the pediatric population. Hence, routine baseline and follow‐up ultrasound of the urinary system should be recommended during the use of TPM in children.     

Efficacy of topiramate in children with refractory status epilepticus

PURPOSE: Status epilepticus (SE) is a life-threatening medical condition associated with significant morbidity and mortality that requires urgent medical intervention. Although several agents are available to treat SE, they occasionally fail to abort seizure activity. Topiramate (TPM) was anecdotally reported to be effective in adult patients with refractory SE. In this study, we evaluated the efficacy of TPM administered to children with this condition. METHODS: We retrospectively reviewed the pediatric SE database at the University of Michigan Medical Center and identified three children with refractory SE who were treated with TPM. Those children failed to respond to treatment with benzodiazepines, phenytoin, phenobarbital, midazolam, or pentobarbital. Additional treatment with TPM was administered by nasogastric tube. All patients were continuously monitored by 21-channel digital EEG machines, and the diagnosis of SE was made by a board-certified neurophysiologist. RESULTS: The ages of the three children were 4.5 months, 34 months, and 11 years. TPM was initiated at 2 mg/kg/day in two children and at 3 mg/kg/day in the third. The status was terminated in all three children within 24 h of maintenance therapy with TPM at 5-6 mg/kg/day. CONCLUSIONS: These results support the potential efficacy of TPM for children with refractory SE. Larger prospective series are needed to confirm those results.     

Efficacy and safety of topiramate in refractory epilepsy: a long-term prospective trial

The effects of topiramate in 15 patients with drug refractory partial epilepsy or Lennox-Gastaut syndrome were assessed in an open, add-on prospective study. After a follow-up of 14–21 months, six patients are still on topiramate (mean dosage 583 mg/day, range 400–800 mg/day), and nine have discontinued treatment because of adverse events (n=6), inefficacy (n=2) or poor compliance (n=1). Nine patients (69%) continued to have a 50% reduction in seizure frequency during the last two months of treatment, and one has been seizure-free for the last 19 months. The most common adverse events were somnolence, weight loss, mental slowing, fatigue, ataxia and irritability. Most of these events were reversible, but withdrawal of treatment was required in six cases as a result of ataxia (two patients), somnolence, metabolic acidosis, irritability or psychotic symptoms (one patient each). It is concluded that topiramate is a valuable agent for the long-term management of refractory epilepsy.

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Sommario Gli effetti di topiramato utilizzato in aggiunta alla terapia preesistente sono stati valutati nell'ambito di uno studio prospettico in aperto in 15 pazienti farmacoresistenti affetti da epilessia parziale o sindrome Lennox-Gastaut. Dopo un follow-up di 14–21 mesi, 6 pazienti sono tuttora in trattamento (posologia media di topiramato 583 mg/die, range 400–800 mg/die), mentre 9 hanno sospeso il farmaco a causa di eventi avversi (n=6), inefficacia (n=2) o scarsa compliance (n=1). Nove pazienti (69%) continuavano a presentare una riduzione di almeno il 50% della frequenza delle crisi durante gli ultimi 2 mesi di trattamento e un paziente è libero da crisi da 19 mesi. Gli eventi avversi più frequenti erano costituiti da sonnolenza, calo ponderale, rallentamento mentale, astenia, atassia e irritabilità. La maggior parte di questi eventi è risultata reversibile, ma in 6 pazienti si è resa necessaria la sospensione del trattamento a causa di atassia (2 casi), sonnolenza, acidosi metabolica, irritabilità e sintomi psicotici (1 caso ciascuno). Sulla base di questi dati, il topiramato può essere ritenuto un utile presidio nel trattamento a lungo termine dell'epilessia farmacoresistente.

     

Concomitant treatment with topiramate and ketogenic diet in pediatric epilepsy

PURPOSE: Topiramate (TPM) is widely used as add-on therapy for epilepsy. TPM inhibits carbonic anhydrase, which may result in metabolic acidosis from decreased serum bicarbonate. The ketogenic diet (KGD) predisposes patients to metabolic acidosis, especially during induction. In children with refractory epilepsy, cotreatment with TPM and KGD may be considered, but special attention should be paid to the combined risks for metabolic acidosis and nephrolithiasis. We report our experience in 14 children cotreated with TPM and the KGD. METHODS: Medical records of 14 children cotreated with the KGD and TPM for medically refractory epilepsy were reviewed retrospectively. Bicarbonate levels were analyzed and correlated with clinical profiles, including duration of cotreatment, TPM dose, KGD ratio, and seizure control. RESULTS: Nine children had a <20% decrease in bicarbonate levels, from 5.3 to 12.3 mEq/L (mean, 7.6 mEq/L). Cotreatment was continued in all patients for duration of 33 to 544 days (seven had remained on cotreatment at the end of the study period), although two children required bicarbonate supplements to continue the KGD. No patient had nephrolithiasis. CONCLUSIONS: Although a large decrease in bicarbonate level occurred in the majority of children, the decrease appeared mostly at the time of KGD induction when added to prior TPM therapy. Bicarbonate levels should be monitored carefully with TPM and KGD cotreatment, and bicarbonate supplements given when symptomatic.     

10例睡眠性头痛临床分析

目的分析睡眠性头痛的临床特点,提高对睡眠性头痛的认识和改善治疗效果。方法分析2006年7月至2010年10月诊治的10例睡眠性头痛的临床表现及治疗结果,并结合文献进行总结。结果10例病例中男4例,女6例,发病年龄从24至61岁,全部病例中6例使用了碳酸锂口服治疗,5例头痛发作完全停止,1例无效而改用氟桂利嗪口服治疗,发作停止;3例则使用了洛美利嗪治疗,头痛发作停止;2例(包括上述提到的1例)使用氟桂利嗪治疗发作停止。结论应提高对睡眠性头痛的认识,首选碳酸锂治疗,如果碳酸锂无效或因药物副作用或其它原因不能使用碳酸锂,则可使用洛美利嗪或氟桂利嗪亦有效。