新型和传统抗癫痫药治疗新诊断癫痫患者的评价  

Evaluation of newly and traditional antiepileptic drugs monotherapy in patients with newly diagnosed epilepsy

作　　者：晏玉奎[1] 狄晴[2] 余年[2] 蒋颖[2] 王凌玲[2] 葛剑青[2] 

机构地区：[1]浙江省湖州市中心医院神经内科,浙江湖州313000 [2]南京医科大学附属脑科医院神经内科,江苏南京210029

出　　处：《中风与神经疾病杂志》2010年第10期894-897,共4页Journal of Apoplexy and Nervous Diseases

基　　金：南京市医学科技发展重大项目(2007-0211)

摘　　要：目的评价新型和传统抗癫痫药(AEDs)单药治疗新诊断癫痫患者的疗效及安全性。方法前瞻性收集143例新诊断癫痫患者,分为卡马西平(CBZ)、丙戊酸钠(VPA)、托吡酯(TPM)和拉莫三嗪(LTG)治疗组,其中CBZ用于癫痫部分性发作,VPA用于癫痫全面性发作,而TPM和LTG用于各种类型癫痫发作,至少观察1年。采用生存分析Kaplan-Meier法比较治疗后癫痫初次发作时间、治疗失败时间,同时比较各组患者达"6月、1年无发作"比例和药物不良反应。结果 4组AEDs单药治疗后至癫痫初次发作时间、治疗失败时间的差异均无统计学意义(P>0.05);CBZ、VPA、TPM和LTG组"6月无发作"率分别为80%、78%、87.9%、63.3%(均P>0.05);"1年无发作"率分别为70%、66%、66.7%、50%(均P>0.05)。TPM组不良反应率为63.3%,高于CBZ组(20%)、VPA组(24%)(均P<0.01),而LTG组不良反应率为16.7%,与CBZ、VPA组相当(均P>0.05)。结论从疗效和安全性综合考虑,新型AEDs治疗癫痫并不优于传统AEDs,其中TPM轻、中度不良反应还明显高于传统AEDs。Objective To evaluate the efficacy and safety of newly and traditional antiepileptic drugs monotherapy in patients with newly diagnosed epilepsy.Methods We prospectively collected 143 patients with newly diagnosed epilepsy who were treated with monotherapy and followed up for at least one year.Carbamazepine （CBZ） was used for patients with partial seizure,sodium valproate （VPA） for generalised seizure,while topiramate （TPM） and lamotrigine （LTG） could be used for both of them.Kaplan-Meier survive analysis was used to analysis time to first seizure and time to treatment failure after treatment.Meanwhile 6-months or 1-year remission and drugs adverse events were also observed and compared.Results The time to first seizure and the time to treatment failure were no statistical significant difference between all AEDs.The proportion of patients for 6-mouths remission in CBZ,VPA,TPM and LTG group was 80%,78%,87.9%,63.3% （allP0.05）;and that for 1-year remission was 70%,66%,66.7%,50%（all P0.05）.The proportion of adverse events was higher in TPM group （63.3%） than in CBZ （20%）,and VPA （24%） group （all P0.01）.While LTG group was 16.7% that was no significant difference compared with CBZ and VPA group.Conclusions Efficacy and safety of newly AEDs were not superior to that of traditional AEDs for treatment of newly diagnosed epilepsy.TPM has more mild to moderate adverse events than CBZ and VPA.

关 键 词：新诊断癫痫 治疗 抗癫痫药 预后 

分 类 号：R742.1[医药卫生—神经病学与精神病学]