新型和传统抗癫痫药物治疗新诊断部分性癫痫的临床研究

Clinical study of new and conventional antiepileptic drugs with newly diagnosed partial epilepsy

目的:比较新型和传统抗癫痫药(AEDs)治疗新诊断部分性癫痫患者的疗效及安全性。方法:收集新诊断部分性癫痫患者的临床资料,分为卡马西平(carbamazepine,CBZ)组、左乙拉西坦(levetiracetam,LEV)组、奥卡西平(oxcarbazepine,OXC)组和拉莫三嗪(lamotrigine,LTG)组,以治疗后稳定期初次发作时间、治疗失败时间和达“6月、1年和2年无发作”比例为观察指标,评估其治疗癫痫的有效性及安全性。结果:本研究共收集250例新诊断部分性发作癫痫患者,分为CBZ组(n=62)、LEV组(n=67)、OXC组(n=63)、LTG组(n=58)。通过Kaplan-Meier统计分析显示新型和传统AEDs治疗癫痫后初次发作时间,CBZ和OXC的疗效相当(Log-Rank=0.226,P=0.635),而CBZ优于LTG(Log-Rank=15.305,P=0.000)和LEV(Log-Rank=8.027,P=0.005);治疗失败时间,CBZ和LTG疗效相当(Log-Rank=0.127,P=0.721),而CBZ优于OXC、LEV,差异均具有统计学意义(Log-Rank=7.000,P=0.008;Log-Rank=5.572,P=0.018)。“6月无发作”率依次为CBZ、LEV、LTG、OXC,但差异无统计学意义(均P>0.05),“1年无发作”率和“2年无发作”率,依次为CBZ、LTG、OXC、LEV,其中CBZ均优于OXC和LEV(均P<0.05),但和LTG比较无统计学差异(均P>0.05)。有25例患者(10.0%)出现不良反应。CBZ的不良反应率为19.3%,高于LTG(8.6%)、OXC(7.9%)、LEV(4.5%)。结论:CBZ治疗部分性癫痫的效果优于OXC和LEV,特别是在治疗的早期阶段,与LTG相当,但副作用的发生率也较高。

AIM:To compare the early response to the new and traditional antiepileptic drugs(AEDs) in the treatment of partial epilepsy.METHODS:Patients from neurology Department of Huzhou Central Hospital between January 2013 and June 2018 were included;outcomes included time to first seizure,time to treatment failure and 6-month,1-and 2-year seizure-free rates were compared.RESULTS:A total of 250 patients with partial epilepsy were divided into carbamazepine(CBZ) group(n=62),levetiracetam(LEV) group(n=67),oxcarbazepine(OXC) group(n=63),and lamotrigine(LTG) group(n=58).In terms of time to first seizure after monotherapy,CBZ and OXC were equivalent(P=0.635),while CBZ was superior to LTG(P LTG > OXC > LEV,and CBZ was superior to OXC and LEV(all P=0.05).A total of 25 patients had adverse reactions;with CBZ(19.3%) more often than LTG(8.6%),OXC(7.9%),or LEV(4.5%).CONCLUSION:Treatment response to CBZ is superior compared to that of OXC and LEV,especially in the early stages of treatment,and equivalent to that of LTG,but the incidence of side effects is higher as well.