奥卡西平联合拉莫三嗪治疗卒中后癫痫效果及脑电图预后评估价值研究

Clinical effect of Oxcarbazepine and Lamotrigine in patients with post-stroke epilepsy and prognostic val-ue of electroencephalogram

目的探讨奥卡西平联合拉莫三嗪在卒中后癫痫患者中的临床效果及脑电图预后评估价值。方法选取2019年2月至2021年1月山西省心血管病医院收治的卒中后癫痫患者146例,按随机数字表法分为2组,对照组单一奥卡西平治疗,研究组联合拉莫三嗪治疗,比较2组临床效果、脑电图预后评估效果、认知功能以及血清神经元特异性烯醇化酶(NSE)、肿瘤坏死因子(TNF)水平情况。结果研究组有效率85%(62/73),对照组有效率79%(58/73),研究组有效率高于对照组(P<0.05);研究组脑电图改善率85%(66/73),对照组脑电图改善率60%(44/73),研究组脑电图改善率高于对照组(P<0.05);研究组治疗后的神经功能缺损评分(NHISS)(7.6±2.1)分,低于对照组(13.0±3.3)分,而简易精神状态量表(MMSE)评分(25.1±1.6)分高于对照组(21.2±1.6)分(P<0.05);研究组治疗后的NSE(41±4)μg/L、TNF-α(23±4)μg/L,均低于对照组的(52±4)μg/L、(36±3)μg/L(P<0.05);研究组治疗后的非对称二甲基精氨酸(ADMA)(0.61±0.10)μmol/L、同型半胱氨酸(Hcy)(7.8±1.0)μmol/L及单核细胞趋化因子(MCP-1)(32±4)μg/L均低于对照组ADMA(0.89±0.09)μmol/L、Hcy(10.0±1.2)μmol/L及MCP-1(44±4)μg/L(P<0.05)。结论卒中后癫痫患者采取奥卡西平与拉莫三嗪联合治疗效果显著,不但可以提高临床效果和改善患者脑电图预后效果,还能改善认知功能,应推广应用。

Objective To investigate the clinical effect of Oxcarbazepine and Lamotrigine in patients with post-stroke epilepsy and the prognostic value of electroencephalogram(EEG).Methods A total of 146 patients with post-stroke epilepsy admitted to Shanxi Provincial Cardiovascular Disease Hospital between February 2019 and January 2021 were included in the study and randomly divided into two groups.The control group was treated with Oxcarbazepine alone.In addition,the study group was treated with Lamotrigine.The clinical effects,progno-sis assessment effects of EEG,cognitive function and serum NSE and TNF levels were compared between the two groups.Results The effective rate in the study group was higher than that in the control group[79%(58/73)vs 85%(62/73),P<0.05)].The improvement rate of EEG in the study group was higher than that in the control group[85%(66/73)vs 60%(44/73),P<0.05)].After the treatment,the NHISS score in the study group was lower than that in the control group[(7.6±2.1)vs(13.0±3.3)],whereas the MMSE score in the study group was higher than that in the control group[(25.1±1.6)vs(21.2±1.6)](both P<0.05).After the treatment,the serum levels of NSE and TNF-αin the study group were lower than those in the control group[(41±4)μg/L vs(52±4)μg/L,(23±4)μg/L vs(36±3)μg/L,both P<0.05].After the treatment,the levels of ADMA,Hcy and MCP-1 in the study group were lower than those in the control group[(0.61±0.10)μmol/L vs(0.89±0.09)μmol/L,(7.8±1.0)μmol/L vs(10.0±1.2)μmol/L and(32±4)ug/L vs(44±4)μg/L,all P<0.05].Conclusion The combined treatment of Oxcarbazepine and Lamotrigine in patients with post-stroke epilepsy shows significant effect,which may not only improve the clinical effect and prognosis of EEG,but also improve cognitive function and therefore is worthwhile of widespread use.