托吡酯和丙戊酸钠缓释片对成年癫患者认知功能的影响

The effects of topiramate and sodium valproate retard tablet on cognitive function in adult with epilepsy

目的:评价托吡酯(topiramate tablet,TPM)与丙戊酸钠缓释片(sodium valproate retard tablet,VAP)对成年癫患者认知功能的影响。方法:62例新确诊成年癫患者随机分为2组,TPM组(30例)与VAP组(32例);采用自身对照研究分别于用药前及用药2个月后采用韦氏修订记忆量表(WMS-RC)与P300检查对癫患者的认知功能做出评估。结果:①服药前TPM组VAP组比较记忆商值(MQ)、ERPs检查中P3波潜伏时间P>0.05,2组间认知功能无明显差异;②TPM组较服药前1→100顺序数数分值下降、100→1倒数水平降低、数字累加分值降低、图片再认错误增加、图片记忆能力降低、图像再生错误率增加、词语联想错误增多、实物触摸困难、故事理解能力降低、顺背反背数字难度增大;ERPs检查中,N1波潜伏时间延长,P2、N2、P3波潜伏时间均明显延长,P3波波幅降低。VAP组WMS-RC测试各分项分值较用药前无显著变化;ERPs检查中,N1波潜伏时间缩短,P2、N2、P3波潜伏时间均缩短明显,P3波幅增高不明显;③WMS-RC中的短期记忆与P3波潜伏时间呈负相关。结论:TPM在加量阶段可以引起癫患者认知功能障碍;VAP对癫患者的认知功能有改善作用;将P300与WMS-RC结合用于癫患者认知功能评估,其结果更客观、全面。

Objective：To evaluate the effects of topiramate（TPM） and sodium valproate retard tablet（VAP） on cognitive function in adult patients with epilepsy. Methods：Sixty-two adult patients,newly diagnosed as epilepsy,were randomly divided into 2 groups： TPM Group （n = 30） and VAP Group （n = 32）. The cognitive function of all the patients in these two groups were evaluated by the Revised Adult Wechsler memory seale（WMS-RC） and event related potentials（ERPs） before treatment and after two months administration of TPM/VAP. Results： ①Before administration of TPM ： Memory Quotient （MQ） 〈 100, accounting for 26.67% ; In the ERPs, the P3 wave latency 〉359.9ms, accounting for 33.33%. Before administration of VAP： MQ 〈 100,accounting for 28.0% ; In the ERPs, the P3 wave latency 〉 359.9ms, accounting for 31.25%. There was not significant difference between these two groups with respect to the cognitive function （P 〉 0.05）. ②After administration of TPM,in TPM Group the score of sequence counts of l to 100 declined （P 〈 0.01 ）,the score of sequence counts of 100 tol declined（P 〈 0.05）, the score of digit cumulate cognitive function declined（P 〈 0.05） ,the mistakes of cards recognition increased（P 〈 0.01 ）, the function of cards remembrance declined（P 〈0.01 ）, the mistakes of cards reclamation increased（P 〈 0.01）,the mistakes of word association increased （P 〈 0.01 ）, the object touch was more difficult （P 〈 0.01 ）, the function of story apprehension declined （P 〈 0.01 ）and the natural order and anti-natural order repeat of digit were more difficult （P 〈 0.01 ）. In the ERPs, the N1 wave latency prolonged （P 〈 0.05） and the P2,N2 and P3 waves lateneies all prolonged significantly（P 〈 0.01 ）,while the amplitude of P3 wave declined（P 〈 0.01 ）. After administration of VAP,in VAP Group：the score of WMS-RC TEST in every item did not change significantly（P 〉 0.05）. In the ERPs,the N1 wave latency shortened（P 〈 0.05） and the P2,N2 and P3 waves latencies all shortened significantly （P 〈 0.01 ）,while the amplitude of P3 wave did not increase significantly （P 〉 0.05）. ③The transient memory of WMS-RC was reversely correlated with the P3 wave latency （P 〈 0.05）. Conclusion： After administrateratien of TPM, patients with epilepsy who were in the drug titration phase were more likely to suffer from many cognitive disturbers;Patients＇ cognitions were improved by administration of VAP;After examination of ERPs and WMS-RC ,the results of evalua- tion of cognitive function will be more objective and comprehensive.