托吡酯治疗小儿癫痫104例临床研究  

Topiramate as used for treating 104 cases of epilepsy in children

作　　者：周水珍[1] 王艺[1] 邱鹏玲[1] 金佩娟[1] 陈天兰[1] 宋义清[1] 孙道开[1] 

机构地区：[1]复旦大学儿科医院癫痫诊治中心,上海200032

出　　处：《中华神经科杂志》2001年第5期283-286,共4页Chinese Journal of Neurology

摘　　要：目的　观察托吡酯添加或单一治疗小儿癫痫 ,特别是对癫痫部分性发作及继发性全身性发作、Lennox Gastaut综合征 (LGS)和West综合征的疗效和不良反应。方法　对癫痫部分性发作或继发性全身性发作 3 2例、LGS 4 7例及West综合征 2 5例病例中已应用传统抗癫痫药物治疗 ,但控制不理想的病例添加托吡酯治疗 ,而新诊断的病例应用托吡酯单一治疗 ,并进行开放性自身对照研究。治疗剂量一般由 0 5～ 1mg·kg-1·d-1开始 ,每周增加 0 5～ 1mg·kg-1·d-1。部分性发作及继发性全身性发作组平均剂量为 ( 6 2± 2 2 )mg·kg-1·d-1;LGS组平均剂量为 ( 7 4± 3 5 )mg·kg-1·d-1;West综合征组 <6个月的患儿由 12 5mg/d开始 ,≥ 6个月的患儿由 2 5mg/d开始 ,每 2～ 3d增加 12 5～ 2 5mg/d ,平均剂量为 ( 8 1± 4 1)mg·kg-1·d-1。结果　 ( 1)托吡酯治疗小儿癫痫 10 4例 ,疗程均在 6个月以上 ,总疗效为 :发作减少≥ 5 0 %的患者 80例 ( 76 9% ) ,发作停止 4 2例 ( 4 0 4 % ) ;( 2 )添加托吡酯治疗对卡马西平和丙戊酸钠的血浓度没有明显影响 ;( 3 )不良反应 :嗜睡 18例 ( 17 3 % ) ,反应淡漠 7例( 6 7% ) ,思维缓慢 3例 ( 2 8% ) ,纳差 2 5例 ( 2 4 0 % ) ,类暑热症 8例 ( 7 7% ) ,体重下降 12例 ( 11 5 % )。Objective To stud y the effect , dose, and adverse events of topiramate (TPM) in treating epilepsy in children , either used as a monotherapy or an add-on therapy. Methods 32 patients using TPM for partial seizures, 47 pa tients for Lennox-Gastaut syndrome (LGS), and 25 for West syndrome were obser v ed with self-controlled, open-label research. The patients were started at a d ose of 0.5～1 mg·kg^-1·d(^-1) TPM,which was increased by 0.5～1 mg· kg(^-1)·d(^-1) per week. Mea n dose was (6.2±2.2) mg·kg(^-1)·d(^-1) for partial seizures, and (7. 4 ±3.5) mg·kg(^-1)·d(^-1) for LGS, and (8.1±4.1) mg·kg(^-1)·d~ -1 for West syndrome. Results (1) In three groups totally 104 cases were treated with TMP to an ave rage course of more than 6 months. There were a 50% or greater reduction from baseline in seizure frequency shown in 80 cases (76.9%), and 42 cases (40.4%) showed no free seizure. (2) The VPA and CBZ serum concentrations in all patien ts with add-on therapy were examined before and after the treatment, showed n o statistical differences.(3) Negative reactions: 18 patients (17.3%) had bad leth argy, 7 patients (6.7%) had apathy, 3 cases (2.8%) had decreased study ability , 25 patients (24.0%) had poor appetite, and another 8 cases (7.7%) did not ha ve sweat in hot days and 12 cases (11.5%) had weight loss. Concl usion TPM proves to be an effective and safe drug f or anti-seizure either used as monotherapy and add-on therapy in children with partial seizures, LGS and West syndrome.

关 键 词：癫痫 抗惊厥药 儿童 临床研究 托吡酯 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R971.6[医药卫生—临床医学]