不同剂量拉莫三嗪治疗老年癫痫的比较研究

Comparative study of different doses of lamotrigine in treatment of elderly epilepsy

目的探讨不同剂量拉莫三嗪治疗老年癫痫患者的临床疗效。方法选择2014年7月—2018年2月洛阳市第三人民医院神经内科诊治的老年癫痫患者88例作为研究对象,根据拉莫三嗪使用剂量分为对照组(40例)和观察组(48例)。对照组患者给予大剂量拉莫三嗪片治疗,拉莫三嗪起始剂量25 mg/d,2周后为50 mg/d,第5周以后为目标剂量100 mg/d,维持100 mg/d治疗观察至第8周。观察组患者给予小剂量拉莫三嗪片治疗,起始剂量25 mg/d,2周后为50 mg/d,第5周以后为目标剂量50 mg/d,维持50 mg/d治疗观察至第8周。观察两组患者的临床疗效,同时比较两组患者蒙特利尔认知评估量表(MoCA)评分、P300潜伏期、波幅和不良反应情况。结果治疗后,对照组和观察组总有效率分别为97.5%、97.9%,两组对比差异无统计学意义。治疗后,两组患者的MoCA评分均显著高于治疗前,同组治疗前后比较差异具有统计学意义(P<0.05);且观察组治疗后的MoCA评分显著高于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,观察组的P300潜伏期显著降低,波幅明显升高,同组治疗前后比较差异具有统计学意义(P<0.05);且观察组治疗后P300潜伏期及波幅显著优于对照组,两组比较差异具有统计学意义(P<0.05)。观察组治疗期间的不良反应发生率为6.3%,显著低于对照组的32.5%,两组比较差异具有统计学意义(P<0.05)。结论相对于大剂量,小剂量拉莫三嗪治疗老年癫痫患者能达到很好的疗效,能减少不良反应的发生,改善患者的神经电生理功能与认知功能。

Objective To investigate the clinical effects of different doses of lamotrigine in treatment of elderly epilepsy.Methods Elderly patients(88 cases)with epilepsy in Luoyang Third People's Hospital from July 2014 to February 2018 were divided into control group(40 cases)and observation group(48 cases)accorded to the dose of lamotrigine.Patients in the control group were given large doses of Lamotrigine Tablets,starting at 25 mg/d,followed by 50 mg/d 2 weeks later,followed by a target dose of 100 mg/d after 5 weeks,and maintained at 100 mg/d until 8 weeks.Patients in the observation group were given a small dose of Lamotrigine Tablets,starting at 25 mg/d,followed by 50 mg/d 2 weeks later,followed by 50 mg/d after 5 weeks,and maintained at 50 mg/d until 8 weeks.After treatment,the clinical efficacy in two groups were observed,and the MoCA score,P300 incubation period,amplitude,and adverse reactions were compared.Results After treatment,the total effective rates in the control group and the observation group were 97.5%and 97.9%,respectively,there was no significant difference between two groups.After treatment,the MoCA scores in two groups were significantly increased,the difference before and after treatment in the same group was statistically significant(P<0.05).And the MoCA score in the observation group was significantly higher than that in the control group,the difference between two groups was statistically significant(P<0.05).After treatment,P300 latency in the observation group was significantly decreased,but the amplitude was increased,the difference in the same group was statistically significant(P<0.05).And the P300 latency and amplitude in the observation group after treatment were significantly better than those in the control group,the difference between two groups was statistically significant(P<0.05).During the treatment,the incidence of adverse reactions was 6.3%in the observation group,which was significantly lower than 32.5%in the control group,the difference between two groups was statistically significant(P<0.05).Conclusion Compared with large dose,small dose of lamotrigine in treatment of elderly epilepsy patients can achieve a good effect,reduce the occurrence of adverse reactions,and improve the patients'neuroelectrophysiological function and cognitive function.