左乙拉西坦联合托吡酯治疗难治性癫痫综合征的疗效及安全性分析

Analysis of efficacy and safety of levetiracetam combined with topiramate in the treatment of refractory epilepsy syndrome

目的分析左乙拉西坦(LEV)联合托吡酯治疗难治性癫痫综合征的疗效及安全性.方法90例难治性癫痫综合征患儿,根据治疗方法不同分为A组、B组及C组,各30例.A组单纯采用LEV治疗,B组单纯采用托吡酯治疗,C组采用LEV联合托吡酯治疗.比较三组患儿不良反应发生情况及治疗前后韦氏儿童智能量表修订版(WISC-R)评分、头颅磁共振波谱、脑电图棘慢波指数.结果治疗后,三组总智商(FIQ)评分、言语智商(VIQ)评分及领悟评分均显著高于本组治疗前,且C组FIQ评分(107.68±2.55)分、VIQ评分(108.15±3.20)分及领悟评分(15.28±2.70)分均高于A组的(100.20±1.83)、(102.36±2.85)、(13.02±1.50)分和B组的(100.15±1.85)、(102.35±2.88)、(13.00±1.52)分,差异有统计学意义(P<0.05).治疗后,三组NAA/Cr、NAA/Cho+Cr与NAA/Cho均显著高于本组治疗前,且C组高于A组和B组,差异有统计学意义(P<0.05).治疗后,三组NREM期、清醒期脑电图棘慢波指数均显著低于本组治疗前,且C组低于A组和B组,差异有统计学意义(P<0.05).三组不良反应发生率比较差异无统计学意义(P>0.05).结论难治性癫痫综合征患儿接受LEV联合托吡酯治疗可显著提升智力水平,改善脑电波指数,不良反应少,疗效显著、安全性高.

Objective To analyze the efficacy and safety of levetiracetam(LEV)combined with topiramate in the treatment of refractory epilepsy syndrome.Methods A total of 90 children with refractory epilepsy syndrome were divided into group A,B and C by different treatment methods,with 30 cases in each group.Group A was treated by LEV therapy,and group B was treated by topiramate,and group C was treated by levetiracetam combined with topiramate.The occurrence of adverse reactions,Wechsler Intelligence Scale revised(WISC-R)score,skull magnetic resonance spectroscopy,spike slow wave index of electroencephalogram before and after treatment were compared among the three groups.Results After treatment,the full intelligence quotient(FIQ)score,verbal intelligence quotient(VIQ)score and comprehension score in three groups were significantly higher than those before treatment.FIQ score(107.68±2.55)points,VIQ score(108.15±3.20)points and comprehension score(15.28±2.70)points in group C were higher than(100.20±1.83),(102.36±2.85),(13.02±1.50)points in group A and(100.15±1.85),(102.35±2.88),(13.00±1.52)points in group B.Their difference was statistically significant(P<0.05).After treatment,the NAA/Cr,NAA/Cho+Cr and NAA/Cho in three groups were significantly higher than those before treatment,and group C was higher than group A and B.Their difference was statistically significant(P<0.05).After treatment,the spike slow wave index of electroencephalogram in NREM and awake period among three groups were significantly lower than those before treatment,and group C was lower than group A and B.Their difference was statistically significant(P<0.05).There was no statistically significant difference in incidence of adverse reactions among three groups(P>0.05).Conclusion LEV combined with topiramate shows significant effects for children with refractory epilepsy syndrome,and it can significantly improve their intelligence level,improve brain wave index with fewer adverse reactions,and high safety.