卡马西平、丙戊酸钠、拉莫三嗪单药对新诊断部分癫痫患者额叶相关认知功能的影响

目的研究卡马西平（CBZ）、丙戊酸钠（VAP）、拉莫三嗪（LTG）对新诊断成人部分发作癫痫患者额叶相关认知功能的影响。方法采用前瞻和随机对照研究，对48例新诊断为部分发作伴或不伴全面发作的癫痫患者进行6项神经心理学测验后，随机给予CBZ、VAP、LTG单药治疗，1月后复查神经心理学检查。结果与治疗前比较CBZ组B型连线测验错误数增加（P〈0．05），汉罗塔（TowerofHanoi）平均计划时间缩短（P〈0．05）；VAP组Stroop读字正确数增加（P〈0．01），威斯康星卡片分类测验，（WSCT）错误数下降（P〈0．05）、非持续错误数下降（P〈0．01）qLTG组倒背数下降（P〈0．01）。治疗后组间比较，有6项神经心理学指标差异有显著性，分别是顺背数（P〈0．05）、词汇总数（P〈0．01）、Stroop读字时间（P〈0．01）、Stroop读字错误数（P〈0．01）、Stroop读色纠正数（P〈0．05）以及汉罗塔平均计划时间（P〈0．01）。结论抗癫痫药物的化学结构和作用机制不同，所以对认知功能的影响也不同；LTG对癫痫患者长期认知功能的影响是有利的。

The Influence of Carba Mazepine, Valproate and Lamotrigine Mate on the Cognitive Function Related to the Frontal Lobe among the Newly Diagnosed Parial Pilepsy

Objective To explore the influence of Carbamazepine(CBZ), Valproate(VAP) and Lamotrigine(LTG) on the cognitive function related to the frontal lobe among the newly diagnosed adult partial epilepsy patients. Methods It was a prospective, randomized and controlled study. According to the diagnostic criteria for epilepsy of the ILAE in 1981 and 1989, 48 newly diagnosed adult patients with partial epilepsy were tested by 6 neuropsychological tests including Digit span, Verbal fluency, Trail making test (TMT), the Stroop test, Wisconsin card sorting test (WCST) and Tower of Hanoi.After the first test all patients were randomly divided into 3 groups administrated CBZ,VAP and LTG, respectively. The same tests were repeated after 1 month later. Results After therapy in CBZ group the error numbers of TMT parts B increased (P<0.05) and the mean planning time of Tower of Hanno declined (P<0.05). In VAP group the connected rates in reading words of the Stroop-test increased (P<0.01) and the error numbers in WSCT declined (P<0.05) and no persistent error numbers declined (P<0.01). In LTG group Digits backwards declined (P<0.01). The difference of neuropsychological index among 3 groups had significance. They were digits forwards (P<0.05), the vocabulary total number (P<0.01), the reading words time of the Stroop-test (P<0.01), the mistakes of reading words (P<0.01),the correcting numbers of the Stroop reading colors (P<0.05) and the mean planning time of Tower of Hanoi (P<0.01). Conclusions Different AEDs have different effects on the neuropsychological function because of their different chemical structure and therapeutic mechanism. LTG is available for diagnosed adult partial epilepsy patients to affect cognitive function in long run.