探讨抗癫痫药物对癫痫患者认知功能的影响

The influence of antiepileptic drugs on cognitive function of epileptic patients

目的探讨抗癫痫药物(AEDs)治疗前后对癫痫患者认知功能的影响。方法收集2015年3月—2016年2月于福建医科大学附属协和医院神经内科新诊断且未接受治疗的癫痫患者28例,根据患者发作类型、病情程度及药物疗效等情况,选择拉莫三嗪(Lamotrigine,LTG)、奥卡西平(Oxcarbazepine,OXC)、丙戊酸钠(Sodium valproate,VPA)3种AEDs之一进行药物治疗,并相应分成三组,其中LTG组11例,OXC组12例,VPA组5例,并对患者随访1年,采用临床记忆量表观察癫痫患者药物治疗前后认知功能的变化。结果与30名健康志愿者比较,新诊断癫痫患者初次测评的临床记忆量表记忆商(P<0.01)、指向记忆(P<0.05)、联想学习(P<0.05)、图像自由回忆(P<0.01)分值明显下降;患者服用AEDs治疗后癫痫发作减少或控制,总有效率达85.7%,随访1年后,临床记忆量表记忆商(P<0.01)、指向记忆(P<0.05)、联想学习(P<0.05)、人物特点联系回忆(P<0.05)分值较治疗前提高,图像自由回忆、无意义图形再认分值较治疗前有所提高,但无统计学意义(P>0.05);LTG组、VPA组治疗后分别在人物特点联系回忆、指向记忆中分值较治疗前提高(P<0.05)。结论癫痫患者在发病初即存在一定程度的认知功能损害。通过规范AEDs治疗,大部分患者可以较好地控制癫痫发作。短期(1年内)服用LTG、OCX、VPA,认知功能无明显下降,且部分认知领域还有所提高。

Objective To investigate the changes of cognitive function of epileptic patients after antiepileptic drugs （AEDs） therapy. Methods Twenty eight cases of epileptic patients with new diagnosis and untreatment from March 2015 to February 2016 were collected. According to the seizure type, degree of attack and drug efficacy, patients were divided into three groups and treated with one of three AEDs, including Lamotrigine （LTG）, Oxcarbazepine （OXC）, and Sodium valproate （VPA）. Among them, 11 were LTG group, 12 were OXC group and 5 were VPA group.Then the patients were followed up for I year. The clinical memory scale was used to analyze cognitive function of epileptic patients before and after therapy. Results Compared to 30 cases of healthy volunteers, the scores of memory quotient （P〈0.01）, directed memory （P〈0.05）, associative learning （P〈0.05） and image free recall （P〈0.01） of epileptic patients were obviously decreased before AEDs therapy.AEDs therapy reduced or controlled seizures in new diagnostic epileptic patients, and the total effective rate was 85.7%. In the clinical memory scale tests, the scores of memory quotient （P〈0.01）, directed memory （P〈0.05）, associative learning （P〈0.05）, portrait characteristics contact memory （P〈0.05） were improved after therapy. The scores of image free recall and meaningless graphics recognition were also improved, but there was no statistical significance. Besides, there was a statistically significant improvement in the score of portrait characteristics contact memory after LTG treatment （P〈0.05）, and directed memory after VPA treatment （P〈0.05）. Conclusions Epileptic patients accomnanied with cognitive deficits before drug Intervention. Through standard AEDs treatment, seizures couldbe better controlled. The cognitive function of epileptic patients was not declined after short-termwithin 1 year intervention of LTG, OCX or VPA. Moreover some parts of the cognitive domain could be improved.