多药物联合治疗难治性癫痫疗效分析
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摘要
目的探讨多药联合治疗难治性癫痫的疗效对比,以求更好的为临床治疗提供参考。方法对难治性癫痫患者分别给予丙戊酸钠(VPA)联合拉莫三嗪(LTG)或托吡酯(TPM)或奥卡西平(OXC)口服,通过电话随访、门诊随访212例难治性癫痫患者,对癫痫发作次数、副作用进行记录,分析癫痫控制率及副作用发生率。结果 189例患者联合治疗后每月发作(12.41±3.07)次,明显低于治疗前3个月每月发作(47.82±8.93)次;3组临床总有效率分别为76.19%、77.78%、82.54%,与治疗前相比均发生明显变化(P<0.05),且加用LTG组不良反应最少。3组治疗后,脑电图检查结果显示均有好转,但是组间对比差异无统计学意义(P>0.05)。结论 VPA+LTG、VPA+OXC或VPA+TPM治疗难治性癫痫均取得满意疗效,且LTG+VPA疗法不良反应最低,具有临床应用优势。
Objective: To explore the efficacy of multi-drug combination therapy for refractory epilepsy in order to provide a reference for clinical treatment. Methods: Patients with refractory epilepsy were treated with sodium valproate combined with lamotrigine or topiramate or oxcarbazepine. The number of seizures and side effects of 212 patients with refractory epilepsy were recorded by telephone follow-up and outpatient follow-up. Rate of incidence and side effects were recorded. Results: 1.189 patients had a monthly onset(12.41±3.07) after treatment, which was significantly lower than that(47.82±8.93) before treatment. The total clinical effective rate of the 2.3 group was 76.19%, 77.78%, and 82.54%, respectively. Significant changes were observed compared with before treatment(P<0.05), and the least adverse reactions were added in the LTG group. After 3 groups of treatment, the results of EEG showed improvement, but there was no significant difference between the groups(P>0.05).Conclusion: In this study, VPA+LTG, VPA+OXC or VPA+TPM has satisfactory results, and LTG+VPA therapy has the lowest adverse reactions and clinical application advantages.
Objective: To explore the efficacy of multi-drug combination therapy for refractory epilepsy in order to provide a reference for clinical treatment. Methods: Patients with refractory epilepsy were treated with sodium valproate combined with lamotrigine or topiramate or oxcarbazepine. The number of seizures and side effects of 212 patients with refractory epilepsy were recorded by telephone follow-up and outpatient follow-up. Rate of incidence and side effects were recorded. Results: 1.189 patients had a monthly onset(12.41±3.07) after treatment, which was significantly lower than that(47.82±8.93) before treatment. The total clinical effective rate of the 2.3 group was 76.19%, 77.78%, and 82.54%, respectively. Significant changes were observed compared with before treatment(P<0.05), and the least adverse reactions were added in the LTG group. After 3 groups of treatment, the results of EEG showed improvement, but there was no significant difference between the groups(P>0.05).Conclusion: In this study, VPA+LTG, VPA+OXC or VPA+TPM has satisfactory results, and LTG+VPA therapy has the lowest adverse reactions and clinical application advantages.
引文
[1] 杨环玲,李哲,杨春清,等.拉莫三嗪、左乙拉西坦、奥卡西平对部分性癫痫患者脑电图的影响[J].实用预防医学,2011,18(6):1078-1079.
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[6] Callaghan BC,Anand K,Hesdorffer D,et al.Likelihood of seizure remission in an adult population with refractory epilepsy[J].Ann Neuro,2007,62(4):382-389.
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[8] French JA,Kanner AM,Bautista J,et al.Efficacy and tolerability of the new antiepileptic drugs.Ⅱ.Treatment of refractory epilepsy:report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society[J].Neurology,2004,62(8):1261-1273.
[9] 中华医学会神经病学分会.脑电图与癫病学组抗癫病药物应用专家共识[J].中华神经科杂志,2011,44(1):56-65.
[10] 陈秋又.拉莫三嚓联合丙戊酸钠治疗儿童难治性癫病临床观察[J].中山大学学报:医学科学版,2009,30(2):113-115.
[11] 李颖,刘艳霞,丛晓楠,等.托吡酯联合丙戊酸钠在难治性癫痫治疗中的应用价值及不良反应的研究[J].中国医药指南,2017,27(10):30-31.
[2] Luat A F,Asano E,Kumar A,et al.Corpus Callosotomy for Intractable Epilepsy Revisited:The Children's Hospital of Michigan Series[J].Journal of Child Neurology,2017,32(7):624.
[3] 邓白荔,周舍典,何清华,等.几种新癫痫药分别联合丙戊酸钠治疗难治性癫痫的对比[J].中国现代药物应用,2014,10(11):3-6
[4] Bourgeois BFD.General concepts of medical intractability//Luders HO.Epilepsy Surgery[M].Philadelphia:Lippincott,Williams&Wilkins,2001:63-68.
[5] Jobst B C,Kapur R,Barkley G L,et al.Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas[J].Epilepsia,2017,58(6):1005-1014.
[6] Callaghan BC,Anand K,Hesdorffer D,et al.Likelihood of seizure remission in an adult population with refractory epilepsy[J].Ann Neuro,2007,62(4):382-389.
[7] 司承庆,潘玉君.丙戊酸钠注射液治疗癫痫持续状态现状[J].中华临床医师杂志:电子版,2012,13(15):3714-3715.
[8] French JA,Kanner AM,Bautista J,et al.Efficacy and tolerability of the new antiepileptic drugs.Ⅱ.Treatment of refractory epilepsy:report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society[J].Neurology,2004,62(8):1261-1273.
[9] 中华医学会神经病学分会.脑电图与癫病学组抗癫病药物应用专家共识[J].中华神经科杂志,2011,44(1):56-65.
[10] 陈秋又.拉莫三嚓联合丙戊酸钠治疗儿童难治性癫病临床观察[J].中山大学学报:医学科学版,2009,30(2):113-115.
[11] 李颖,刘艳霞,丛晓楠,等.托吡酯联合丙戊酸钠在难治性癫痫治疗中的应用价值及不良反应的研究[J].中国医药指南,2017,27(10):30-31.