盐酸哌甲酯治疗儿童良性癫痫伴中央颞区棘波合并注意缺陷多动障碍的安全性研究

Safety of methylphenidate hydrochloride in the treatment for childhood benign epilepsy with centrotemporal spikes combined with attention deficit hyperactivity disorder

目的探讨盐酸哌甲酯治疗儿童良性癫痫伴中央颞区棘波(BECTS)合并注意缺陷多动障碍(ADHD)的安全性及对癫痫发作的影响。方法选取2007年4月至2008年10月广州市儿童医院神经内科确诊的40例BECTS合并ADHD患儿,经抗癫痫药物治疗临床无发作达6个月以上,加用盐酸哌甲酯,每6个月复查1次脑电图(EEG),评价患儿注意力和行为改善情况,记录癫痫发作次数、类型以及其他副反应,将患儿用药前后的癫痫发作情况进行自身对照研究。结果 40例中37例用药时间超过6个月,注意力、多动及对立违拗行为明显改善。4例发生副反应;2例用药1周内发作增多;1例用药1年后出现1次发作;1例用药2d内出现入睡困难,停药后发作及入睡困难停止。患儿服用盐酸哌甲酯前后癫痫发作及其他副反应出现情况差异无统计学意义(P>0.05)。结论抗癫痫药控制临床发作的同时,在规范剂量范围内使用盐酸哌甲酯治疗BECTS合并ADHD具有安全性。

Subject To explore whether use of methylphenidate hydrochloride（Ritalin） will induce the attack of benign children epilepsy with centrotemporal spikes combined with attention deficit hyperactivity. Methods A total of 40 cases of BECTS and ADHD ,whose clinical attack stopped for more than 6 months after the treatment with anti-epileptic drugs, were given Ritalin. EEG was reexamined every 6 months, and at the same time,the attention and behavior situation with CONNER＇S scale and Achenbach child behavior checklist （CBCL）were reevaluated. The seisure frequency,type and adverse events after using Ritalin were recorded and compared with the dada before using Ritalin.Results Totally 37 cases of the 40 received the treatment for more than 6 months,which resulted in obvious improvement. Four cases had side effects.Attacks increased in two cases a week after using Ritalin; one case developed sleep difficulty 2 days after using Ritalin;another case had one seizure attack after using Ritalin for one year. The attacks were under control after withdrawal of Ritalin. There was no significant difference （P 〉 0.05） between the induced symptoms before and after taking Ritalin. Conclusion It is safe to use methylphenidate hydrochloride to treat children with BECTS combined and ADHD, while controlling seizures with antiepileptic drugs.