左乙拉西坦添加治疗学龄期难治性癫痫患儿认知功能与生活质量的影响

目的观察并探讨左乙拉西坦(levetiracetam,LEV)添加治疗对学龄期难治性癫痫(refractory epilepsy,RE)患儿认知功能与生活质量的影响。方法入选2013年6月至2015年12月收治的55例RE儿童为研究对象,所有患儿在继续原有治疗方案基础上行LEV添加治疗16周,起始剂量8~10 mg/(kg·d),逐步加量至50 mg/(kg·d),达标后维持剂量30 mg/(kg·d),期间记录药物不良反应,治疗结束后判定临床疗效,采用韦氏儿童智力量表评价患儿认知功能,采用儿童癫痫生活质量量表评价生活质量改变。结果患儿治疗后癫痫平均发作次数(3.8±1.3 vs.6.6±2.3)次/月较入组前明显下降(P0.05)。治疗后临床控制率、显效率、有效率、无效率分别为9.1%、36.4%、43.6%、10.9%,总体有效率为89.1%。患儿治疗后WISC-CR智力评价中算术(10.9±2.6 vs.9.2±2.1)、填图评分(15.1±3.9 vs.13.8±3.3)较治疗前显著提高(P0.05)。患儿治疗后QOLCE评价中生活质量总分(65.7±5.7vs.62.8±4.9)及认知功能(60.0±5.7 vs.57.4±6.2)、社会功能(65.0±6.3 vs.62.5±5.5)评分显著高于治疗前(P0.05)。服药期间,患儿头晕、乏力、嗜睡、易激惹、欣快感、一过性转氨酶升高发生率分别为12.7%、9.1%、20.0%、5.5%、3.6%、3.6%;16周服药保留率96.4%。结论 LEV添加治疗能显著减少RE患儿癫痫发作次数,并有助于改善患儿认知功能与生活质量,但应注意LEV对精神行为的影响。

Influence of Levetiracetam adjunctive therapy on cognitive function and life quality in school-age children with refractory epilepsy

Objective To examine the influence of LEV adjunctive treatment on cognitive function and life quality in RE school-age children. Methods Fifty-five cases of RE children were selected from our hospital from June 2013 to December 2015. Based on original treatment all children were added with LEV treatment for 16 weeks. The initial dose was 8~10 mg/(kg·d),and gradually increased to 50 mg/(kg·d). maintenance dose was 30 mg/(kg·d). Adverse drug reac?tions were recorded and clinical efficacies were determined after treatment. Wechsler Intelligence Scale for Children re?vised in China (WISC-CR) and quality of life in children with epilepsy (QOLCE) was used to evaluate children's cogni?tive function and children's life quality, respectvely. Results Average epilepsy attack frequencies after treatment (3.8± 1.3 vs. 6.6±2.3) times/month decreased significantly compared with before treatment (P<0.05). Clinical control ratio, ex?cellent ratio, effective ratio and ineffective ratio after treatment were 9.1%, 36.4%, 43.6%, 36.4%respectively and total effective ratio was 89.1%. The arithmetic score (10.9 ± 2.6 vs. 9.2 ± 2.1) and mapping score (15.1 ± 3.9 vs. 13.8 ± 3.3) in WISC- CR evaluation increased significantly (P<0.05). Life quality score (65.7 ± 5.7 vs. 62.8 ± 4.9) , cognitive function score (60.0 ± 5.7 vs. 57.4 ± 6.2) and social function score (65.0 ± 6.3 vs. 62.5 ± 5.5) after treatment in QOLCE evaluation in?creased significantly (P<0.05). During medication, the incidences of dizziness, fatigue, lethargy, irritability, euphoria and transient aminotransferase elevation were 12.7%, 9.1%, 20.0%, 9.1%, 3.6%and 3.6%respectively. Sixteen week medica?tion retention rate was 96.4%. Conclusion LEV adjunctive treatment can significantly reduce epilepsy attacks and im?prove cognitive function and life quality in RE children, but attention should be paid to LEV's influence on mental behavior.