甲泼尼龙治疗癫痫患儿效果及影响因素分析

Study on the effects of methylprednisolone in epilepsy children with antiepileptic drugs treatment failure and the influencing factors of efficacy

目的癫痫是一种慢性神经系统疾病,主要由于集体部分神经元同步异常放电造成。本研究分析甲泼尼龙用于抗癫痫药物(antiepileptic drugs,AEDs)治疗失败小儿癫痫的效果及影响因素。方法选择鞍山市中心医院2016-02-01-2017-03-01收治的60例经AEDs治疗失败的癫痫患儿,均予以甲泼尼龙治疗,观察临床治疗效果、相关影响因素及患儿复发率。结果甲泼尼龙治疗60例AEDs失败小儿癫痫总有效率为65.00%(39/60),其中8例得到控制、23例显效、8例有效。既往用药种数之间甲泼尼龙治疗的有效率差异无统计学意义,χ~2=2.389,P=0.303。28例脑电图高峰失律患儿经治疗后的转归率为7.14%(2/28),32例脑电图为尖波、棘波、棘慢波患儿经治疗后的转归率为6.25%(2/32),两种脑电图类型患儿的转归率差异无统计学意义,χ~2=0.0191,P=0.890;多因素分析结果显示,既往用药数量>4种(OR=4.758,95%CI为1.475～15.350,P=0.009)和月发作频率>4次(OR=6.128,95%CI为2.168～17.321,P=0.001)为影响疗效的不良因素;随访1年,患儿复发率为30.00%(18/60)。结论甲泼尼龙用于AEDs治疗失败患儿癫痫具有一定效果,但既往用药数量>4种和月发作频率>4次的患儿疗效较差。

OBJECTIVE To investigate the efficacy of methylprednisolone in the treatment of epilepsy children with antiepileptic drugs(AEDs) treatment failure.METHODS 60 cases of epileptic children who failed to receive AEDs treatment in our hospital from February 2016 to March 2017 were selected,and all of them were treated with methylprednisolone.The curative effect,influencing factors and recurrence rate were observed.RESULTS The total effective rate of methylprednisolone in the treatment of AEDs failure was 65.00%(39/60).Among them,8 cases were controlled,23 cases were markedly effective and 8 cases were effective.There was no significant difference in the efficacy of methylprednisolone between the number of drugs used in the past(χ^2=2.389,P=0.303).The clinical outcome rate in 28 children with hyperarrhythmia was 7.14%(2/28),and the clinical outcome rate in 32 children with sharp wave,spike wave and spike slow was 6.25%(2/32).There was no significant difference in the outcome rate between the two groups(χ^2=0.0191,P=0.890).Multivariate logistic regression analysis showed that the used drugs>4 kinds(OR=4.758,95%CI:1.475-15.350,P=0.009) and monthly seizure frequency>4 times per month(OR=6.128,95%CI:2.168-17.321,P=0.001) were the risk factors for poor effects.After 1 year follow-up,the recurrence rate was 30.00%(18/60).CONCLUSIONS The application of methylprednisolone in epilepsy children with AEDs treatment failure can relieve the condition of disease.And the effect is poor in children whose used drugs are more than 4 kinds and monthly seizure frequency is more than 4 times.