婴儿期局灶性癫痫的药物治疗反应分析  

Analysis on drug therapeutic response for infantile focal epilepsy

作　　者：廖双[1] 钟雪飞[2] LIAO Shuang;ZHONG Xuefei(Department of Neurology,Affiliated Children′s Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China;Department of Editorial Office,Affiliated Children′s Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院/国家儿童健康与疾病临床医学研究中心/儿童发育疾病研究教育部重点实验室/儿科学重庆市重点实验室神经内科,400014 [2]重庆医科大学附属儿童医院/国家儿童健康与疾病临床医学研究中心/儿童发育疾病研究教育部重点实验室/儿科学重庆市重点实验室儿科药学杂志编辑部,400014

出　　处：《重庆医学》2021年第23期4079-4082,共4页Chongqing medicine

基　　金：重庆市科卫联合医学科研项目(2018MSXM052);重庆医科大学附属儿童医院科研项目(lcyj2015-10)。

摘　　要：目的探讨婴儿期局灶性癫痫对不同抗癫痫药物的治疗反应,为临床合理用药、减少癫痫发作提供临床数据支持。方法选择2013年12月至2017年7月在该院神经内科诊断并治疗的婴儿期局灶性癫痫患儿25例,随访时间至少18个月,分析不同抗癫痫药物的治疗有效率。结果25例患儿均经发作期视频脑电图证实为局灶性起源癫痫。起病年龄中位数为6.38个月(1~15个月),男女比例为1.27∶1.00,随访时间中位数为38.40个月(18~60个月)。10例诊断为良性(非)家族性婴儿癫痫,13例诊断为癫痫脑病(包括2例婴儿痉挛症),另外2例为无法归类癫痫患者。发作期放电起源部位以颞区居多(36.00%),其次是枕区(20.00%)和额区(20.00%)。整个队列一共使用了6种抗癫痫药物(AEDs),其中以左乙拉西坦(LEV)使用率最高(37.50%),其次为奥卡西平(OXC,17.86%)和丙戊酸钠(VPA,16.07%)。首次单药治疗选择最多的AEDs为LEV。首次单药、二联用药或换用第二种AEDs、三联用药或换用第三种AEDs的抗癫痫治疗有效率分别为28.00%、52.17%和59.09%。VPA(n=4)和OXC(n=2)在良性(非)家族性婴儿癫痫中的应答率均很高(100%)。癫痫脑病患儿中84.62%(11/13)使用了大于或等于3种AEDs仍有频繁发作,仅1例使用VPA联合LEV后发作控制。25例患儿无1例因药物不良反应而停药。结论婴儿期局灶性癫痫的药物治疗反应及临床转归与癫痫分类密切相关,VPA可作为一线药物选择。Objective To investigate the therapeutic response of infantile focal epilepsy on different anti-epileptic drugs to provide the clinical data support for clinical rational drug use and reducing epilepse attack.Methods Twenty-five children patients with infantile focal epilepsy diagnosed in the neurology department of this hospital from December 2013 to July 2017 were selected and followed up for at least 18 months.The effective rates of different anti-epilepsy drugs(AEDs)were analyzed.Results Total 25 cases of focal origin epilepsy were verified by the video electroencephalogram during attack stage.The median onset age was 6.38 months(1-15 months)and the male to female ratio was 1.27∶1.00.The median follow-up duration was 38.40 months(18-60 months).Ten cases were diagnosed as benign familial(nonfamilial)infantile epilepsy,13 cases as epileptic encephalopathy(including 2 cases of infantile spasm),and other 2 cases as unclassified epilepsy.The discharge origin sites in attack period were mainly the temporal area(36.00%),followed by the occipital area(20.00%)and frontal area(20.00%).The whole cohort used six AEDs,in which levetiracetam had the highest use frequency(37.50%),followed by oxcarbazepine(OXC,17.86%)and valproic acid(VPA,16.07%).Levetiracetam(LEV)was the most selected AEDs for initial monotherapy.The effective rates of anti-epilepsy therapy in the first time single drug,two-drug combined use or replacing the second AEDs,three-drug combination or replacing the third AEDs were 28.00%,52.17%and 59.09%respectively.The response rates of OXC(n=4)and VPA(n=2)were higher in benign nonfamilia(familial)infant epilepsy(100%).84.62%(11/13)of the children patients with epileptic encephalopathy used≥3 kinds of AEDs,but there were still frequent attacks.Only 1case used VPA combined with LEV and the attack was controlled.Among 25 cases,no case stopped the drug due to the drug adverse reactions.Conclusion The drug treatment response and clinical outcome are closely correlated with the epilepsy classification.VPA may ser

关 键 词：局灶性癫痫 婴儿期 抗癫痫药物 治疗 视频脑电图 

分 类 号：R720.5[医药卫生—儿科]