丙戊酸镁缓释片治疗癫痫的临床观察

目的观察丙戊酸镁缓释片治疗各种类型癫痫的疗效和安全性。方法分别用单药和添加治疗各类癫痫患者88例,添加组39例,在原有抗癫痫药基础上,按成人每日0.5～1.5g,儿童15～30mg·kg^-1·d^-1,于早、晚两次口服丙戊酸镁缓释片;单药组49例,成人起始剂量为每日口服丙戊酸镁缓释片0.5g,每周增加剂量不超过0.5g,最大剂量不超过每日2.0g;儿童按15～30mg·kg^-1·d^-1,最大不超过40mg·kg^-1·d^-1。服药24周根据发作频率减少情况进行疗效评定。结果对各种类型的癫痫发作治疗总控制率为43.2%,总显效率为23.9%,总有效率为81.8%,无一例出现发作次数增多。单药治疗组控制率为51.0%,显效率为22.4%,总有效率为83.7%;添加治疗组控制率为33.3%,显效率为25.6%,总有效率为79.5%。两组相比,单药组治疗效果略高于添加治疗组,但差异无统计学意义。单药治疗疗效较为明显者为失神发作、强直发作、肌阵挛发作、失张力发作等,而局灶性发作仅占50.0%;添加治疗组其疗效较为明显者是继发强直阵挛性发作（90.0%）。不良反应主要为头昏、体重增加、嗜睡、脱发、血小板减少、一过性氨基转移酶升高等,多数患者反应较轻,只要从小剂量开始,加药速度慢,注意肝功能等检查,就能够坚持服药。虽然此药比较安全,但在发育期女性及孕妇中应用仍然要慎重。随访一年以上患者依从性较好。结论丙戊酸镁缓释片具有较好的临床疗效和药物依从性,是较理想的抗癫痫药物。

Clinical observation on the therapeutic effect of sustained release tablets of magnesium valproate in 88 cases of epileptic seizure

Objective To observe the efficacy and safety of sustained release tablets of magnesium valproate in 88 various type epileptic seizure.Methods 88 patients with epilepsy were divided into two groups.39 patients who have had many AEDs in turn served as add-on therapy group,and 49 newly diagnosed patients who had never accepted standard therapy entered monotherapy group.In adults,the initial dose was 500 mg(given twice per day),the maintenance dose was 500～1 000 mg,maximum did not surpass 2 000 mg.In children,the initial dose was 15～30 mg·kg-1·d-1,and maximum did not surpass 40 mg·kg-1·d-1.During the first 24 weeks of treatment therapeutic effect evaluation was carried out both in monotherapy group and add-on therapy group according to seizure frequency reduction.Results The total control rate was 43.2%,total excellence rate was 23.9%,total effective rate was 81.8%,for different epileptic seizure.Neither occurrence seizure frequency was increased.Among monotherapy group,control rate was 51.0%,excellence rate was 22.4%,total effective rate was 83.7%;in add-on therapy group control rate was 33.3%,excellence rate was 25.6%,total effective rate was 79.5%.In monotherapy group good therapeutic effect was seen in patients with absence seizure,tonic seizure,myoclonic seizure and atonic seizure.It's side effects were dizziness,fat,somnolence,alopecia,thrombopeny,transaminase increasing temporality,etc.Most reaction were light and can insist on dose,but pregnant women still need discretion.Good treatment compliance in patients was observed during more than 1 year's follow-up.Conclusions Sustained release tablets of magnesium valproate has well therapeutic effect,well dependence,it is an ideal antiepileptic drug.