甲泼尼龙对其他抗癫痫药物治疗失败伴癫痫性痉挛的癫痫性脑病疗效观察  

Therapeutic effect observation of Methylprednisolone for epileptic encephalopathy with epileptic spasms after other antiepileptic medicines were failure

作　　者：贾天明[1] 甘玲[1] 杜开先[1] 张晓莉[1] 董燕[1] 李小丽[1] 刘苗苗[1] 申丽[1] 

机构地区：[1]郑州大学第三附属医院儿内科,450052

出　　处：《中华实用儿科临床杂志》2016年第12期903-906,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：河南省医学科技攻关项目（201403105）

摘　　要：目的探讨甲泼尼龙对其他抗癫痫药物（AEDs）治疗失败伴癫痫性痉挛的癫痫性脑病的疗效及安全性。方法58例具备痉挛发作表现并经视频脑电图或动态脑电图证实为癫痫性痉挛发作的患儿，经2种及2种以上AEDs治疗无效或失败后，先予大剂量维生素B。排除维生素B。依赖症，再予大剂量甲泼尼龙冲击治疗5d并口服泼尼松维持治疗8～12周，在应用甲泼尼龙基础上对其原有AEDs进行调整，在甲泼尼龙冲击后1周、1个月、3个月、6个月、12个月进行定期随访。结果使用甲泼尼龙冲击治疗伴癫痫性痉挛的癫痫性脑病治疗1周时有效率为86．2l％，控制率为34．48％；1个月时有效率为72．41％，控制率为31．03％；3个月时有效率为63．79％，控制率为32．76％；6个月时有效率为65．52％，控制率为29．31％；由于住院时间先后顺序不同，随访至12个月者24例，有效率为62．50％，控制率为33．33％。23例应用促皮质素治疗失败的患儿，应用甲泼尼龙冲击治疗1周时有效率为65．22％，控制率为21．74％；1个月时有效率为52．17％，控制率为17．39％；3个月时有效率为47．83％，控制率为17．39％；6个月时，有效率为47．83％，控制率为21．74％。58例伴癫痫性痉挛的癫痫性脑病患儿中，不良反应主要表现为冲击治疗期间烦躁不安、哭闹、睡眠增多、血压轻度升高，在冲击结束后1周时均消失；随访至1—2个月有3例患儿出现向心性肥胖，激素减停后逐渐恢复，随访至12个月未见其他不良反应。结论甲泼尼龙冲击治疗是伴癫痫性痉挛的癫痫性脑病有效、安全的治疗方法，可应用于其他AEDs治疗失败的患儿。Objective To discuss the efficacy and safety of Methylprednisolone therapy to treat epileptic en- cephalopathy with epileptic spasms after other antiepileptic medicines failed. Methods Fifty - eight children with epi- lepsy seizures were confirmed by videoelectroencephalogram（ video -EEG） or EEG,and they were given large dose of Vitamin Bs to exclude Vitamin Bs dependent diseases. In addition, they were given large dose of Methylprednisolone therapy for 5 days and treated with prednisone for 8 to 12 weeks. Finally, the followed -ups were performed after pa- tients were treated for 1 week, 1 month,3 months,6 months, and 12 months. Results The effective percentages of treat- ment corresponded with Methylprednisolone therapy, including the effective control rate of 86.21% and seizure -free of 34.48% of them at 1 week. At 1 month, the effective rate was 72.41% and 31.03% of the patients with seizure - free. The effective rate was 63.79%, control rate was 32.76% at 3 months. At 6 months, the effective control rate was 65.52%, and control rate was 29.31%. Due to the different duration of hospitalization,24 children were followed up af- ter 12 months and 62.50% of the patients responded to the large dose of Methylprednisolone therapy, including seizure - free in 33.33 % of them. Twenty - three children, whose Adrenocorticotropic hormone treatment failed, then re- ceived Methylprednisolone therapy and the effective rate were 65.22%, 52. 17%, 47.83%, 47.83% at 1 week, 1 month,3 months,and 6 months, and the corresponding control rates were 21.74%, 17.39%, 17.39% ,21.74%. The side effects of 58 children spasms were irritation, crying, sleeping more, pressure elevating slightly during therapy. The symptoms disappeared after 1 week. Central obesity was found in 3 cases in 1 to 2 months after the treatment, then they recovered gradually after hormone discontinued. Other adverse reactions were not found in 12 months. Conclusions Methylprednisolone therapy is efficient and safe for epileptic spasms,it could be applied to the

关 键 词：癫痫性痉挛 甲泼尼龙 疗效 

分 类 号：R742.1[医药卫生—神经病学与精神病学]