维拉帕米添加治疗难治性癫痫的临床研究

目的 研究维拉帕米作为添加剂，采用剂量递增法治疗难治性癫痫部分性发作的疗效和安全性。方法 对48例难治性部分性发作患者（男28例，女20例，年龄14～56岁）进行维拉帕米添加治疗的开放性自身对照研究，原服用的抗癫痫药种类和剂量不变。维拉帕米剂量递增给药方法为：第1周120mg／d，第2周240mg／d，第3周360mg／d，第4周420mg／d，分2次口服，连续观察半年。结果 43例完成维拉帕米剂量递增添加治疗。总有效率为65％，其中单纯部分性发作（SPS）有效率为78％，复杂部分性发作（CPS）为65％，继发性全身性发作（SGS）为54％。同添加治疗前比较，总的发作频率减少为68％，其中SPS为72％，CPS为65％，SGS为59％。脑电图呈中度或重度异常的患者比例由74％下降到45％。治疗前后血压、心率、心电图及肝、肾、血、尿等化验检查均无明显变化。抗癫痫药血药浓度除卡马西平升高外（P〈0.05），其余未见明显变化。7例患者出现轻度副反应，但未影响治疗。结论 维拉帕米作为添加剂，用剂量递增法治疗难治性癫痫部分性发作，疗效确切，安全性较高。

Verapamil used as an add-on therapy in an increasing dosage for the treatment of drug-resistance partial epilepsy

Objective To study the efficacy and safety of verapamil used as an add-on therapy with increasing dosage for the treatment of drug-resistance partial seizures(DRPS).Methods 48 patients with DRPS received verapamil add-on therapy more than 6 months from Jan 2001 to Jan 2005 in addition to the medication of existing antiepileptic drug.The administration of verapamil in increasing dosage was executed as follows:the initial dosage was 120 mg/d in the first week,240 mg/d for the second week,360 mg/d for the third week and 420 mg/d for the forth week.The patients were studied continuously for 6 months.Results 2 patients dropped out for personal reasons,three cases discontinued verapamil add-on therapy because of untolerable adverse effects of increase dosage.43 cases accomplished the whole course of 6-months treatment.Total effective ratio was 65%,in which there was 78% for simple partial seizurew(SPS),65% for complex partial seizures(CPS) and 54% for the secondary general seizures(SGS).There was a seizure reduction of 68% as compared with pre-verapamil treatment period(P<0.01),showing 72% for SPS,65% for CPS and 59% for SGS respectively.The patients with severe and mediate abnormal EEG reduced a ratio from 76% to 47%.The changes of blood pressure,heart rate,EKG,and clinical tests of liver,kidney,blood and urine in the pre-verapamil add-on period were insignificant as compared with post-verapamil add-on period.The blood level of antiepiletic drugs were also insignificant as compared with post-verapamil add-on period,except for cabamazpine(P<0.05).7 cases had manifestations of mildly adverse effects,but no influence on the treatment.Conclusion Verapamil as an add-on therapy with increasing dosage has a definite efficacy and a higher safety for the treatment of DRPS.