拉考沙胺联合奥卡西平对难治性癫痫患儿神经递质、发作频次的影响

Effects of lacosamide combined with oxcarbazepine on neurotransmitters and seizure frequency in children with refractory epilepsy

目的观察拉考沙胺联合奥卡西平对难治性癫痫患儿神经递质、发作频次的影响。方法收集2020年1月—2021年4月唐山市妇幼保健院儿科收治难治性癫痫患儿156例的临床资料,按照随机数字表法分为对照组、观察组各78例。对照组采用奥卡西平治疗,观察组采用拉考沙胺联合奥卡西平治疗。比较2组治疗前及治疗4周、8周、12周癫痫发作频次,治疗前、治疗后3个月智力情况、神经损伤指标[S-100β蛋白(S-100β)、神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)、髓鞘碱性蛋白(MBP)]、神经递质[5-羟色胺(5-HT)、多巴胺(DA)、去甲肾上腺素(NE)]水平,以及不良反应发生率。结果观察组治疗4周、8周、12周癫痫发作频次均低于对照组(t=3.606、3.876、4.458,P均<0.001);观察组治疗后3个月操作智商(PIQ)、语言智商(VIQ)、总智商(FIQ)评分均高于对照组(t/P=2.899/0.004、3.111/0.002、2.891/0.004),血清S-100β、NSE、GFAP、MBP水平均低于对照组(t/P=2.670/0.008、2.600/0.010、3.420/0.001、2.960/0.004),5-HT、DA、NE水平均高于对照组(t/P=2.775/0.006、2.971/0.003、3.215/0.002);2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论拉考沙胺联合奥卡西平治疗难治性癫痫患儿效果显著,可有效控制癫痫发作,调节神经递质水平,减轻神经损伤,降低癫痫对智力产生的影响,且安全性较高。

Objective To observe the effects of lacosamide combined with oxcarbazepine on neurotransmitters and seizure frequency in children with refractory epilepsy.Methods The clinical data of 156 children with refractory epilepsy admitted to the Pediatrics Department of Tangshan Maternal and Child Health Hospital from January 2020 to April 2021 were collected and divided into the control group and the observation group with 78 cases in each group according to the random number table method.The control group was treated with oxcarbazepine,and the observation group was treated with lacosamide combined with oxcarbazepine.The frequency of epileptic seizures before treatment,4 weeks,8 weeks,and 12 weeks of treatment,intelligence status,and nerve injury indexes[S-100βprotein(S-100β),neuron-specific enolase(NSE)before treatment and 3 months after treatment were compared between the two groups,glial fibrillary acidic protein(GFAP),myelin basic protein(MBP)],neurotransmitter[serotonin(5-HT),dopamine(DA),norepinephrine(NE)]levels,and the incidence of adverse reactions.Results The frequency of epileptic seizures in the observation group after 4 weeks,8 weeks and 12 weeks of treatment was lower than that in the control group(t=3.606,3.876,4.458,all P<0.001).The scores of operational intelligence quotient(PIQ),verbal intelligence quotient(VIQ),and total intelligence quotient(FIQ)in the observation group were higher than those in the control group 3 months after treatment(t/P=2.899/0.004,3.111/0.002,2.891/0.004).The levels of S-100β,NSE,GFAP and MBP were lower than those of the control group(t/P=2.670/0.008,2.600/0.010,3.420/0.001,2.960/0.004),and the levels of 5-HT,DA and NE were higher than those of the control group(t/P=2.775/0.006,2.971/0.003,3.215/0.002).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Lacosamide combined with oxcarbazepine has a significant effect in the treatment of children with refractory epilepsy,which can effectively control epileptic seizures,regulate neurotransmitter levels,reduce nerve damage,and reduce the impact of epilepsy on intelligence,with high safety.