甲泼尼龙冲击治疗难治性癫痫伴痫性痉挛的临床研究

Therapeutic effect study of methylprednisolone pulse therapy for refractory epilepsy complicated with epileptic spasms

目的探讨甲泼尼龙冲击治疗难治性癫痫伴痫性痉挛(ES)的临床疗效及安全性。方法分析2013年1月至2016年3月期间,本院收治的难治性癫痫伴ES患者44例,采用大剂量甲泼尼龙冲击治疗(20mg·kg^(-1)·d^(-1))×5d后改为泼尼松片(1~2mg·kg^(-1)·d^(-1))口服维持治疗8~12w。随访6个月统计临床疗效及不良反应。结果随访1w、1个月、3个月、6个月,ES控制率依次为38.64%、34.09%、34.09%、31.82%,ES总有效率依次为88.64%、70.45%、65.91%、65.91%,脑电图(EEG)完全缓解率依次为9.09%、6.82%、4.55%、4.55%,总缓解率依次为50.00%、45.45%、45.45%、43.18%;21例随访至12个月,ES控制率及总有效率为33.33%、61.90%,EEG完全缓解率和总有效率为4.76%、42.86%;住院期间不良反应率为20.45%,均在1w自行缓解。结论甲泼尼龙冲击治疗难治性癫痫伴ES疗效显著且安全可耐受,值得推广应用。

Objective To investigate the clinical efficacy and safety of methylprednisolone pulse therapy for refractory epilepsy complicated with epileptic spasms （ ES ） . Method Clinical data of 44 refractory epilepsy patients complicated with ES in our hospital from January 2013 to March 2016 were retrospectively analyzed,all patients received methylprednisolone pulse therapy （ 20mg kg-1 d-1 ） for 5 days, then received prednisone （ 1-2mg kg-1 d-1 ） orally for 8 to 12 weeks.The Finally. tile followed-ups were performed after patients were treated for 6 months, the clinical efficacy and adverse reactions were counted. Results At I week, 1 month, 3 months, and 6 months of follow-up, the control rate of ES was 38.64%, 34.09%, 34.09%, 31.82%; the total efficiency rate of ES 88.64%, 70.45%, 65.91%, 65.91% respectively; the complete remission rate of EEG was 9.09%, 6.82%, 4.55%, 4.55%; the total remission rate of EEG was 50.00%, 45.45%, 45.45%, 43.18% respectively; 21 patients were followed up after 12 months, 4.76% of patients received ES control and 42.86% were effective,including 4.76% EEG complete remission and 42.86% total remission rate of EEG of them;During the hospitalization,there was 20.45% of the patients with drug adverse reaction but disappeared after 1 week. Conclusion Methylprednisolone pulse therapy is efficient and safe for refractory epilepsy REEs complicated with ES, it can be popularized in chnical practice.