托吡酯治疗伴有脑结构严重异常儿童癫痫疗效观察.docVIP

托吡酯治疗伴有脑结构严重异常儿童癫痫疗效观察 　［摘要］ 目的 观察托吡酯对有严重脑结构损害的儿童癫痫患者的疗效。方法 回顾性分析我院神经内科门诊就诊的伴有明显影像学异常的62例患者的临床资料。结果 本组病例托吡酯平均维持量6.3 mg/（kg·d）。应用托吡酯单药/添加治疗中，发作减少75%以上达67.7%，完全控制无发作（gt;6个月）达41.9%。在完全控制无发作患儿中，单药治疗组明显高于添加治疗组（P＜0.01）。11.3%的患者随着发作控制精神运动及智力水平有明显进步，仅1.6%患者因不良反应而退出。结论 随着经验的积累，新型抗癫痫药托吡酯在伴有影像学严重异常的儿童癫痫患者治疗中，有较高的有效控制率，治疗中更强调个体化调整。 ［关键词］ 癫痫；结构异常，脑；托吡酯；儿童 Analysis of therapeutic efficacy of topiramate in children with epilepsy and severe brain structure abnormality ［Abstract］ Objective To observe the therapeutic efficacy of topiramate（TPM） in children epilepsy with severe brain structure abnormality.Methods Sixty-two children with epilepsy and severe brain structure abnormality were evaluated retrospectively， and were divided into groups of monotherapy and add-on therapy to make a compared analysis.Results The average maintenance dose of TPM in all children was 6.3 mg/（kg·d）. The rate of seizure decrease gt;75% in all children was 67.7%， and the rate of seizure complete control was 41.9%. In children of seizure complete control， the complete control power of monotherapy group was higher than that of add-on therapy group. In add-on therapy group，13.8%children cannot be effective control.About 11.3% children had visible improvement in psychomotor and intelligence， and only 1.6% children exited the observation for adverse effect.Conclusion TPM had high effective control power in children with epilepsy and severe brain structure abnormality. Individuation，long-term therapy were emphasized， neurosurgery ought to be considered in specified situations. ［Key words］ epilepsy;structural abnomalities，brain；topiramate;children 临床上，伴有影像学异常的儿童癫痫多考虑为继发性癫痫。虽然癫痫的诊断不需要影像学证据，但有严重脑结构损害的癫痫患者常常症状严重，且癫痫长期反复发作又会加重患者的病情及脑功能损害。目前，新型抗癫痫药托吡酯（topiramate，TPM）在癫痫部分性发作中的明显疗效及突出的安全性已被国内外认同。除添加治疗外，还可在儿童期单药治疗［1］。本文对2000年10月～2003年3月在我院神经内科门诊就诊的62例伴严重脑结构损害的癫痫患儿，依据门诊完整的病历和影像学资料，进行回顾性分析，总结如下。 1 资料与方法 1.1 一般资料 本组62例患儿中男39例，女23例；均为临床和脑电图确诊的癫痫患儿，伴头CT/MRI异常。年龄1岁6个月～18岁（平均7岁1个月），病程1～12年（平均4年8个月），TPM疗程6个