左乙拉西坦添加或单药治疗睡眠期癫痫电持续状态疗效观察

Clinical observation on levetiracetam as add-on or monotherapy of electrical status epilepticusin during sleep

目的探讨左乙拉西坦对于睡眠期癫痫性电持续状态(ESES)的患儿临床治疗疗效。方法对于50例癫痫合并ESES患儿给予左乙拉西坦添加治疗(13例)或单药治疗(37例)。在治疗前后观察临床发作、长程视频脑电图以及智商情况,分析左乙拉西坦对于消除ESES现象,控制临床发作方面的作用,及对患儿认知的影响。结果 2例病例失访,共48例患儿完成了至少1年的随访,29例患儿发作完全控制,8例患儿发作减少50%以上,11例患儿无效,临床发作有效率为77.1%;棘波指数(SWI)减少超过75%者有14例(29.2%),减少超过50%者11例(22.9%),总有效率为52.1%。治疗前后自身对照后发现在操作能、言语能和总智商方面差异均无统计学意义(P均>0.05)。左乙拉西坦对于变异型良性儿童癫痫伴中央颞区棘波(ABECT)的脑电图有效率为69.6%,显著高于其他综合征。结论左乙拉西坦治疗ESES对临床发作及睡眠期的SWI均有改善作用,并且安全有效,长期口服左乙拉西坦没有对患儿造成认知损害。左乙拉西坦对于ABECT疗效优于其他综合征。

Objective To explore the efficacy of the Levetiracetam treatment of Electrical Status Epilepticusin in Sleep（ESES）. Methods Totally 50 cases of epilepsy children with ESES were treated with Levetriacetam add-on therapy（13cases）and monotherapy（37cases）.The clinical seizures,long-term video EEG and intelligence were observed before and after therapy to analyse the eliminate of the ESES,the controlling of the role of clinical seizures,and the influence of Levetiracetam on the cognition. Results 2cases were lost to follow-up,48 cases were finished at least 1year of follow-up.The seizures of 29 patients were completely controlled,8cases reduced more than 50%,11 cases were invalided.The clinical effective rate was 77.1%,the reduce of more than 75% of Spike Wave Index（SWI）were 14cases（29.2%）,that of more than50% of SWI were 11cases（22.9%）,the total effective rate was 52.1%.There were no significant difference on the operation ability,verbal ability and total IQ before and after treatment.The effective rate of the treatment of atypical benign epilepsy with central and temporary（ABECT）was 69.6%,significantly higher than other syndromes. Conculsions Levetiracetam is efficient and safety.Long-term treatment of levetiracetam has no cognitive impairment of the children.Levetiracetam is more efficient to patients with ABECT than other epileptic syndrome.