托吡酯治疗成人癫痫部分性发作

目的 :观察托吡酯单药和与不同抗癫痫药(AEDs)合用治疗成人癫痫部分性发作疗效、剂量和不良反应的关系。方法 :A组 (n =31)托吡酯与酶诱导剂AEDs合用 ;B组 (n =19)托吡酯与非酶诱导剂AEDs合用 ;C组 (n =5 1)单用托吡酯。托吡酯剂量为 :开始 12 .5～ 2 5mg·d- 1,每周根据疗效增加12 .5～ 2 5mg·d- 1,分 2次口服 ,共 2 0wk。观察各组疗效、剂量和不良反应。结果 :A组有效率 61%,B组为 68%,C组为 88%,A和B组疗效相似 ,P >0 .0 5 ;C组疗效高于A和B组 ,P <0 .0 5。 3组间有效治疗剂量差异无显著意义。不良反应率A组38%,B组 2 1%,C组 31%,P >0 .0 5 ,2例合用卡马西平出现严重精神症状。结论 :托吡酯是治疗癫痫部分性发作有效药物 ,与不同AEDs合用在疗效、剂量和不良反应方面差异无显著意义。中枢神经系统少见严重不良反应 ,但值得重视。

Topiramate in treatment of partial seizures in adults

AIM:To observe the clinical effects, dose and adverse reactions of topiramate for partial seizure in adults compined with or without other antiepileptic drugs (AEDs). METHODS: One hundred and one patients were divided into three groups. Group A(n=31) patients received topiramate with enzyme-inducing antiepileptic drugs (AEDs), such as carbamazepine, phenobarbital and phenytoin. Group B(n=19) patients received topiramate with AEDs without inducing properties of enzyme, such as valproic acid and lamotrigine. Group C(n=51) received topiramate alone. Topiramate dose:12.5-25 mg·d -1 at first, then increased by 12.5-25 mg·d -1, bid every week according to therapy effects, for 20 wk. The efficacy was assessed by comparing the seizure frequency at the period of maintenance to baseline period before topiramate was used.The therapeutic dose and adverse reactions were recorded. RESULTS: The total effective rates were 61 % for group A,68 % for group B and 88 % for group C. Seizure free in patients was achieved by 35 %(n=11) for group A, 37 %(n=7) for group B and 76 %(n=39) for group C. There was no significant difference between the group A and group B(P> 0.05), but that of group C was higher than that of group A and B(P<0.05). No significant difference for the effective therapeutic dose was found among three groups.The effective dose was 12.5 mg·d -1 in one patient. The topiramate dose of the patients who have no clinical efficacy was significantly higher than that of the patients who have clinical efficacy among three groups. No correlation was observed between the used dose of topiramate and the patients who had no clinical efficacy. Clinical efficacy was correlated with severity of epilepsy and sensitivity of topiramate. The incidences of adverse reactions were 38 % for group A, 21 % for group B and 31 % for group C.There was no significant difference among three groups(P>0.05). Adverse reactions were observed in three patients with topiramate 25 mg·d -1, two patients with carbamazepine exhibited severe psychotic symptoms. CONCLUSION:Topiramate is an effective antiepileptic drug for partial seizure. It can be used in combination with different AEDs or as monotherapy. Topiramate monotherapy is more effective in earlier periods. There was no statistical difference on clinical efficacy, therapeutic dose and adverse reactions of topiramate with different AEDs. The dose of therapy for patients is varied. Occurring of adverse reactions is related to individuality.The severe psychotic symptoms of concomitant carbamazepine are rare and should be noticeable.