左乙拉西坦治疗儿童失神癫癎的疗效

Effect for Levetiracetam Therapy on Childhood Absence Epilepsy

目的探讨左乙拉西坦(LEV)治疗儿童失神癫癎(CAE)的疗效。方法选择2008年1月-2010年12月于本院诊治的CAE患儿65例。男35例,女30例;就诊年龄5～14(7.8±3.5)岁。发病年龄3～12(7.1±3.0)岁。病程为1个月～4.3 a[(12.2±9.8)个月]。随机分为LEV组(33例)和丙戊酸钠(VPA)组(32例)。分别接受LEV及VPA治疗,LEV开始剂量为10 mg·kg-1·d-1,每周加量1次,逐渐加量至20～30 mg·kg-1·d-1,最大剂量40 mg·kg-1·d-1。VPA治疗剂量为15～40 mg·kg-1·d-1,血药质量浓度控制在50～100 mg·L-1。治疗期均为24周,观察2组发作控制的效果和药物不良反应。结果 LEV组9例(27.2%)完全控制,15例(45.5%)部分控制,总有效率72.7%;VPA组11例(34.4%)完全控制,15例(46.9%)部分控制,总有效率81.3%。2组总有效率比较差异无统计学意义(P>0.05)。2组均未出现不能耐受而中断治疗的病例,LEV组不良反应轻微,3例诉头晕,2例出现困倦、乏力;VPA组不良反应较多,5例患儿体质量明显增加,4例学习成绩明显下降。结论 LEV对大部分CAE疗效满意,且不良反应小。

Objective To evaluate the efficacy of levetiracetam （LEV） therapy on childhood absence epilepsy（CAE）. Methods Sixty - five children with CAE were enrolled from the 102^th Hospital of People＇s Liberation Army ,the Mental Health Institute of the Second Military Medical University from Jan. 2008 to Dec. 2010. Among 65 patients ,35 cases were male and 30 cases were female. The children＇s age ranged from 5 to 14 years old with an average of （7.8 ± 3.5） years. The onset age ranged from 3 to 12 years with an average of （7.1 ± 3.0） years. The course of disease ranged from 1 month to 4.3 years with an average of （ 12.2 ± 9.8） months. The patients were divided into 2 groups,33 cases of the LEV group which receive LEV therapy and 32 cases of the valproate sodium（VPA） group which receive VPA therapy. The initial dosage of LEV was 10 mg· kg^-1 · d^-1. It was gradualy increased and the maintenance dosage was 20 - 30 mg · kg^-1·d^-1 and didn＇t exceed the maximum dosage of 40 mg · kg^-1 · d^-1. The dosage of VPA was 15 -40 mg· kg^-1 · d^-1 ,and a plasma concentration of 50 - 100 mg· L^-1 was obtained. Treatment cycle was 24 weeks and treatment effects were observed. Results In LEV group, seizure - free occurred in 9 ca- ses （27.2%）, 15 eases（45.5% ） of partial control, with a total efficiency of 72.7% ;in VPA group, the number was 11 cases （34.4%）, 15 cases（46.9% ） of partial control,with a total efficiency of 81.3%. There was no significant difference in the total effective rates between the 2 groups （ P 〉 0.05 ）. None of patients in the 2 groups dropped out of the study. The LEV group showed with mild adverse reaction, including 3 cases of dizziness,2 cases of drowsiness and fatigue; VPA group showed with more adverse reaction, including 5 cases of obvious weight gain,4 cases of academic records declined markedly. Conclusions LEV can be considered to be the first line treatment for children with CAE,but a large prosepeetive trial is necessary.