拉莫三嗪及丙戊酸钠联合治疗儿童难治性癫痫临床探究.docVIP

拉莫三嗪及丙戊酸钠联合治疗儿童难治性癫痫临床探究 　【摘要】 目的：了解丙戊酸钠（VPA）和拉莫三嗪（LTG）治疗儿童难治性癫痫的疗效。方法：收集儿童难治性癫痫21例，已在使用VPA且血药浓度在有效范围内（50～100 μg/mL）者，即从0.15 mg/(kg·d)、1次/d开始加LTG，第1个月每周增加0.2 mg/(kg·d)，第2个月每周增加0.3 mg/(kg·d)，以后每周增加0.5～1 mg/(kg·d)，直至发作控制或剂量达10 mg/(kg·d)。未使用VPA者，从20 mg/(kg·d)开始加VPA，并调整血药浓度至50～100 μg/mL，再逐渐减停其它抗癫痫药物，加LTG，方法同上。随访发作情况，监测不良反应。结果：治疗9个月时10例（47.6%）完全控制，5例（23.8%）有效，6例（28.6%）无效，治疗后发作频率减少，差异有统计学意义（Plt;0.005），5例（23.8%）脑电图恢复正常，8例（38.1%）出现不良反应。结论：LTG和VPA联用为一种有效、安全而经济的治疗小儿难治性癫痫的方法。 【关键词】 拉莫三嗪 丙戊酸钠 难治性癫痫 儿童 自身对照 ［Abstract］ Objective:To study the effect in children with intractable epilepsy who were treated with combination of valproic acid sodium（VPA）and lamotrigine.Methods:Lamotrigine of 0.15 mg/(kg·d) was added to the patients with normal serum level at 50～100 μg/mL who were already treated with VPA, the dosage being increased by 0.2 mg/(kg·d) per week in the first month, 0.3 mg/(kg·d) per week in the second month and then 0.5～1 mg/(kg·d) per week till free from the seizure or up to 10 mg/(kg·d). The patients not treated with VPA were added with VPA untill a valid serum concentration was reached and then dosages of other antiepilepsic drugs were cut down till stopped in use, meanwhile lamotrigine was applied in the same ways mentioned above. The episodes of seizures and side effects were recorded.Results:After 9 months of treatment, seizures of 10 patients (47.6%) were under control, 5 patients (23.8%) had an effective reduction in numbers of seizures, but the treatment was ineffective in 6 patients (28.6%). The difference in the number of seizures before and after treatment was significant (Plt;0.05). 5 patients (23.8%) had normal electroencephalograms after 9month treatment. 8 patients (38.1%) had adverse reactions.Conclusions:LamotrigineVPA combination therapy is an effective, safe and economic method for children with intractable epilepsy. ［Key words］ Lamotrigine; Valproic acid sodium; Intractable epilepsy; Children; Selfcontrol 随着小儿神经学的发展，越来越多的癫痫儿童得到良好控制，但仍有25%的儿童癫痫成为难治