丙戊酸钠治疗学龄期全身强直阵挛发作性癫痫儿童的效果及对认知功能的影响  

Effects of sodium valproate on epilepsy and cognitive function in the treatment of epilepsy in school-age children

作　　者：张洋 周孟玲[2] ZHANG Yang;ZHOU Meng-ling(Department of Pediatrics,Tianjin Taida Hospital,Tianjin 300457,China;Department of Neonatology,Tianjin Children’s Hospital,Tianjin)

机构地区：[1]天津市泰达医院儿科,300457 [2]天津市儿童医院新生儿内科

出　　处：《天津医药》2018年第7期733-737,共5页Tianjin Medical Journal

摘　　要：目的评价丙戊酸钠(VPA)单药治疗学龄期癫痫患儿的治疗效果、不良反应及对认知功能的影响。方法 60例用VPA治疗的学龄期全身强直阵挛发作性癫痫患儿给予单纯VPA治疗,以10 mg/(kg·d)为起始治疗剂量,之后每周增加5 mg/(kg·d)并逐渐加量,到维持治疗剂量20~30 mg/(kg·d)。前4周选择药物加量治疗,后12周选择药物减量治疗;每周进行一次观察记录患者治疗信息。治疗前、后分别行韦氏儿童智力量表测定,分析VPA的治疗效果、不良反应及对患儿认知功能的影响。结果 60例患儿治疗总有效率为86.7%(52/60)。治疗后积木、译码评分显著低于治疗前,语言智商(VIQ)和全量表智商(FIQ)评分与治疗前比较差异无统计学意义,操作智商(PIQ)治疗后较治疗前降低(P<0.05);学龄期癫痫患儿治疗前后发病年龄与全量表智商(FIQ)、言语智商(VIQ)、操作智商(PIQ)评分呈正相关(P<0.001);癫痫病程和发作频率与FIQ、VIQ、PIQ呈负相关(P<0.001)。加量期间(前4周)不良反应发生率8.33%(5/60)。维持治疗期间(后12周)观察到的不良反应发生率为11.67%(7/60)。结论癫痫发病年龄越早、病程越长、发作的频率越高,其对认知功能的损害就越大,而VPA对于治疗学龄期儿童全身强直阵挛发作性癫痫的疗效显著,是临床治疗儿童癫痫的理想药物。Objective To investigate the effects and adverse reactions of sodium valproate(VPA)on cognitive function in school-age children with epilepsy.Methods A total of 60 school-age children with epilepsy and treated with a single dose of VPA were included in this study.The 5 mg/(kg·d)were added to the initial dose of 10 mg/(kg·d),and gradually increased to maintain therapeutic doses of 20-30 mg/(kg·d).Patients were given for drug dosage treatment at the first 4 weeks,and drug reduction therapy for 12 weeks.The treatment information was recorded weekly.Wechsler Intelligence Scale was used to analyze the therapeutic effects,adverse reactions and cognitive function before and after treatment.Results The total effective rate was 86.7%(52/60).The block and decoding scores were significantly lower after treatment than those before the treatment.There were no significant differences in verbal IQ(VIQ),and the full-scale IQ(FIQ)before and after treatment.The performance IQ(PIQ)was significantly lower after treatment than that before treatment(P<0.05).There was a positive correlation between the age of onset,FIQ,VIQ and PIQ in school-age children with epilepsy(P<0.001).The duration of epilepsy and the frequency of epileptic seizures were negatively correlated with FIQ,VIQ and PIQ before and after treatment in school-age children with epilepsy(P<0.001).The incidence of adverse reactions was 8.33%(5/60)during the period of drug dosage treatment(the first 4 weeks).The incidence of adverse reactions was 11.67%(7/60)during maintenance treatment(after 12 weeks).Conclusion The earlier seizure onset,the longer epilepsy duration and the higher frequency of seizures are correlated with the damage degree of cognitive function.VPA has a significant effect on the treatment of generalized tonic clonic seizure in school-age children,which is an ideal drug for clinical treatment of children with epilepsy.

关 键 词：癫痫 丙戊酸钠 儿童 疗效 认知功能 

分 类 号：R742.1[医药卫生—神经病学与精神病学]