左乙拉西坦治疗中老年部分性发作癫痫患者的临床研究

The clinical efficacy and adverse effects of levetiracetam treatment in the middle and old aged patients with partial seizures

目的分析左乙拉西坦（LEV）单药及添加药物治疗中老年部分性发作（PS）或继发全面性发作（SGTCS）癫痫患者的有效率及不良反应。方法采用自身对照方法，应用LEV对59例PS和SGTCS的中老年癫痫患者进行单药及添加药物治疗，目标维持剂量为1000～2000mg／d，分2次给药。观察LEV的有效率和不良反应，并分别分析LEV在仅患癫痫患者和合并其他疾病的癫痫患者以及单药和添加药物治疗患者之间有效率的差别及意义。结果服用LEV后在第3、6、9和12个月末时的有效率分别为76．2％、70．6％、64．3％和66．7％，不同观察点的临床疗效差异无统计学意义（χ^2=1．911，P=0．591），在合并其他基础疾病用药的癫痫病例中LEV仍显示较好的疗效，12个月末两组间比较，疗效差异无统计学意义（P〉0．05）。LEV对不同癫痫发作类型的临床疗效比较差异无统计学意义（6个月末χ^2=1．315，P〉0．05，12个月末χ^2=2．700，P〉0．05）。在控制无发作比例上在6个月末和12个月末单药治疗明显比添加药物治疗高（χ^2=10．83，P〈0．05）。总不良反应发生率为13．6％，主要为嗜睡、乏力、恶心、食欲不振、头疼、易激惹和记忆力减退。结论LEV单药及添加药物治疗PS、SGTCS癫痫疗效确切，尤其在合并非抗癫痫用药的患者中，临床疗效同样稳定、持续。

Objective To analyse the effective rate and adverse effect of only levetiracetam （LEV） versus LEV plus other drugs in the treatment of middle and old aged patients with partial seizures （PS） and secondary generalized tonic-clonic seizure （SGTCS）. Methods The self-control study was used and 59 elderly patients with PS and SGTCS were treated with LEV single or plus drug （therapeutic dose was 1000-2000 mg/d, bid）. The effective rate and the side effects of LEV were observed and compared between LEV single and plus drug or between the patients with only epilepsy versus epilepsy plus other diseases, respectively. Results The effective ratios at the end of 3,6,9 and 12 months after LEV treatment were 76.2%, 70.6 %0, 64. 3% and 66.7%, respectively and there were no significant difference among above time points （χ^2= 1. 911,P〉0.05）. A chi-square test showed that the differences in effective ratios were not statistically significant （P〉 0.05） between single and combination of drugs （χ^2 = 1. 437） and between two groups of patients at the end of 12 months. Clinical effect of LEV showed no remarkable difference between different types of epilepsy at the end of 6 months （χ^2=1.315, P〉0.05）and 12 months（χ^2=2.700, P〉0.05）. The control ratio of epileptic attack was higher in single LEV than in combination drugs （χ^= 10.83, P〈0.05）. The total side effects were 13.6 %, including somnolence, weakness, anorexia, headache, irritability and forgetfulness. Conclusions The curative effects of levetiraeetam single or in combination are definite, stable and continuous for PS and SGTCS, especially in combination with other diseases.