左乙拉西坦添加治疗Lennox-Gastaut综合征临床疗效观察和脑电图改变

Observation of clinical effects and changes of electroencephalogram in adjunctive treatment of lennox-gastaut syndrome by levetiracetam

目的 研究左乙拉西坦(LEV)添加治疗儿童癫痫性脑病Lennox-Gastaut综合征(LGS)的临床疗效和脑电图(EEG)改变。方法 选取2014年1月至2018年5月在河北省儿童医院神经内科就诊47例LGS患儿,在原有药物治疗的基础上添加LEV口服,对比治疗前和治疗后4w、8w的癫痫发作控制有效率、EEG改善情况和安全性评价。结果 47例患者,在不同的癫痫发作类型中,强直发作、不典型失神发作、阵挛发作、强直-阵挛发作、强直-失张力发作、失张力发作、肌阵挛发作、癫痫样痉挛发作总有效率分别是63.3%、64.3%、50%、60%、50%、60%、61.5%、65%,(P>0.05)。47例癫痫发作的患者中34例患者视频脑电图(VEEG)有效率72.3%;11例患者(23.4%)无缓解;2例患者(4.3%)EEG恶化。醒睡各期治疗后较治疗前癫痫放电指数均显著减少(P<0.001)。17例(36.2%)患者报道了不良事件,多动症5例(10.6%),疲劳3例(6.4%),嗜睡3例(6.4%),指压性水肿1例(2.1%),食欲不振、呕吐、睡眠欠佳、皮疹等其他不良事件5例(10.6%),所有不良事件均未危及生命。结论 LEV添加治疗儿童癫痫性脑病LGS是一种安全有效的治疗方法。

Objective To study the clinical efficacy and EEG changes of LEV in the adjunctive treatment of LGS in child epileptic encephalopathy. Methods 47 children with LGS admitted from January 2014 to May 2018 to the department of neurology,in the Children’s Hospital of Hebei Province were selected.LEV for oral administration was added to the original drug therapy,and the effective rate of seizure control,EEG improvement and safety evaluation of 4 w and 8 w before and after treatment were compared. Results Among different types of seizure in the 47 patients,the effective rate of tonic seizure, atypical absence seizure,clonic seizure,tonic-clonic seizure, tonic-tension seizure,tension seizure,myoclonic seizure and epileptic spasm was 63.3%,64.3%,50%,60%,50%,60%,61.5%,65%,respectively.There was no significant difference in total efficiency(P > 0.05).Of the 47 patients with epilepsy,34 patients had a 72.3% effective VEEG;11 patients(23.4%) had no remission;2 patients(4.3%) had EEG deterioration.The discharge index was significantly decreased after treatment than before in the period of waking and sleeping(P < 0.001).Adverse events were reported in 17 patients(36.2%),with 5 cases(10.6%) of hyperactivity,3 cases(6.4%)of fatigue,3 cases(6.4%)of lethargy,1 case(2.1%)of pitting edema,5 cases(10.6%)of inappetence,vomiting,poor sleep,rash and other adverse events,all of which were not life-threatening. Conclusion LEV is a safe and effective adjunctive treatment for LGS in child epileptic encephalopathy.