左乙拉西坦及托吡酯添加硫必利治疗儿童难治性Tourette综合征的临床对比研究

Clinical comparative study on the feeicacy of levetiracetam and topiramate added tiapride in the treatment of refractory Tourette syndrome in children

目的比较左乙拉西坦及托吡酯添加硫必利治疗儿童难治性Tourette综合征的疗效及安全性。方法选取广州市妇女儿童医疗中心2016年1月-2019年2月门诊收治的60例Tourette综合征的患儿(年龄8~12岁)随机分成两组,在单独使用硫必利治疗效果不佳的基础上分别给予添加左乙拉西坦(LEV)及托吡酯(TPM),其中49例完成治疗,LEV组24例,TPM组25例,疗程8周。分别采用耶鲁抽动症状严重程度量表(YGTSS)和不良反应量表(TESS)对治疗前、治疗后第2、4、8周的治疗效果和不良反应进行评估。结果在治疗开始后第2、4、8周末,LEV组及TPM组YGTSS评分均较服药前下降,但TPM组在上述各个时间段的YGTSS评分较LEV组下降更显著,两组间差异有统计学意义(t=4.185、7.787、10.521,P<0.05)。LEV组于2、4、8周末的有效率分别为50.0%、54.2%、45.8%;TPM组于2、4、8周末的有效率分别为76.0%、80.0%、80.0%。8周时两组的有效率比较,差异均有统计学意义(χ^2=6.151,P<0.05)。LEV组与TPM组的不良反应发生率分别为12.5%及16.0%,差异无统计学意义(χ^2=0.130,P>0.05)。结论LEV与TPM都可有效用于添加治疗儿童难治性Tourette综合征,短期(8周)TPM的疗效优于LEV,两种药物短期的不良反应均较少,耐受性可。

Objective To compare the efficacy and safety of levetiracetam and topiramate plus tiapride in the treatment of refractory Tourette syndrome(TS)in children.Methods From January 2016 to February 2019,60 TS children aged 8~12 years were randomly divided into two groups.Because of the poor therapeutic effect of tiapride alone,the two groups were additionally given levetiracetam(LEV)and topiramate(TPM)respectively.Finally 49 children completed the treatment for 8 weeks,of which,24 in levetiracetam group and 25 in topiramate group.Yale Global Tic Severity Scale(YGTSS)and Treatment Emergent Symptom Scale(TESS)were used to evaluate the effects and adverse reactions before and after treatment for 2,4,8 weeks.Results At the 2 nd,4 th and 8 th weekend after treatment,YGTSS scores in LEV group and TPM group were lower than those before treatment,but YGTSS scores in TPM group were significantly lower than those in LEV group at each time period(t=4.185,7.787,10.521,P<0.05).The effective rates of LEV group were 50.0%,54.2%and 45.8%at the end of 2,4 and 8 weeks,and those of TPM group were 76.0%,80.0%and 80.0%respectively.The effective rates of the TPM group at 2,4,and 8 weekends were 76.0%,80.0%,and 80.0%,respectively.The effective rate of the two groups at the end of the 8 th week was significantly different(χ^2=6.151,P<0.05).The incidence of adverse reactions in the LEV group and the TPM group were 12.5%and 16.0%,respectively(χ^2=0.130,P>0.05).Conclusions Both LEV and TPM can be effectively applied to treat refractory TS in children.The short-term(8 weeks)efficacy of TPM is better than that of LEV.Both drugs have fewer short-term adverse reactions and tolerable.