中低剂量左乙拉西坦在成人部分性癫痫初始治疗中的疗效探究  

Efficacy of low to moderate doses of levetiracetam as initial monotherapy in adult patients with partial epilepsy

作　　者：郭佳南 田林郁[1] 刘文钰[1] 陈佳妮[1] 周东[1] 

机构地区：[1]四川大学华西医院神经内科,成都610041

出　　处：《华西医学》2017年第5期643-648,共6页West China Medical Journal

基　　金：国家自然科学基金(81420108014)

摘　　要：目的探究中低剂量左乙拉西坦(levetiracetam,LEV)作为成人部分性癫痫患者初始治疗的疗效及其可能的预测因素。方法回顾2011年3月—2015年12月就诊于四川大学华西医院癫痫门诊并纳入癫痫门诊数据库的患者资料,从中筛选出新诊断部分性癫痫且以LEV作为初始治疗的成人患者,分析其疗效与其他临床资料。结果共纳入96例患者,71例达到1年无痫性发作,其中48例(50.0%)经LEV单药治疗后即达到无痫性发作,23例(24.0%)在LEV初始治疗后添加其他抗癫痫药物后达到1年无痫性发作。71例患者中,69例(97.2%)通过中低剂量的LEV(500~1 500 mg/d)单药或联合其他抗癫痫药物即达到无痫性发作。在多因素logistic回归模型中,初始治疗前的基线发作频率高可预测LEV初始治疗疗效不佳(P=0.019)。结论中低剂量LEV作为成人部分性癫痫患者的初始治疗疗效及耐受性均较好。初始治疗前的基线发作频率高是LEV初始治疗疗效不佳的独立预测因素。Objective To explore the efficacy of low to moderate doses of levetiracetam in adult patients with newly diagnosed partial epilepsy and possible predictors for poor treatment response. Methods We retrospectively analyzed the clinical data of patients treated in West China Hospital from March 2011 to December 2015 whose clinical data were input into the Epilepsy database. Patients with newly diagnosed partial epilepsy and whose initial anti-epileptic drug was levetiracetam were screened out for this study. Their clinical data, especially responses to the treatment of levetiracetam were reviewed. Results Ninety-six patients were included in this study. Seventy-one of them achieved seizure-free for a complete year after initial treatment of levetiracetam. Forty-eight patients （50.0%） achieved seizure-free with levetiracetam monotherapy; 23 patients （24.0%） achieved seizure-free for one year with levetiracetam combination therapy. Sixty-nine （97.2%） of the 71 patients achieved seizure-free with low to moderate doses of levetiracetam （500 to 1 500 mg/day）, with or without combination of other antiepileptic drugs. High baseline seizure frequency before initial therapy was an independent predictor of poor levetiracetam response in this multivariate logistic regression mode （P=0.019）. Conclusions Low to moderate levetiracetam is both effective and well tolerated in newly diagnosed partial epilepsy patients. High baseline seizure frequency before initial therapy is an independent predictor of poor levetiracetam response.

关 键 词：左乙拉西坦 部分性癫痫 初始治疗 无痫性发作 

分 类 号：R742.1[医药卫生—神经病学与精神病学]