不同抗癫痫发作药物单药治疗在卒中后癫痫中的保留率和有效性分析

The retention rate and efficacy analysis of different anti-seizure medication monotherapy in post-stroke epilepsy

目的比较不同的抗癫痫发作药物(ASM)单药治疗在卒中后癫痫(PSE)患者中的保留率和有效性。方法回顾性收集2019年5月至2022年5月在首都医科大学附属北京天坛医院被首次诊断PSE并接受单药治疗的92例患者的临床资料并对患者进行随访。根据使用ASM种类对患者进行分组,采用χ2检验比较不同ASM的1年药物保留率的差异,并通过秩和检验比较癫痫发作频率来评价不同ASM对PSE的有效性。结果本研究中PSE患者最常用的抗癫痫药为左乙拉西坦(55例,63.95%)、丙戊酸钠(23例,20.93%)和奥卡西平(14例,11.63%)。在1年随访中,左乙拉西坦的药物保留率为76.36%(42/55),奥卡西平为71.43%(10/14),丙戊酸钠为43.46%(10/23),左乙拉西坦和奥卡西平的药物保留率高于丙戊酸钠,差异具有统计学意义(χ2=7.892、4.026,P=0.05、0.045)。左乙拉西坦单药治疗组患者的癫痫发作频率为2.0(0,4.0)次/月,奥卡西平单药治疗组为1.0(0,4.0)次/月,丙戊酸钠单药治疗组为2.5(0,6.0)次/月,但组间比较差异均无统计学意义(P>0.05)。结论新型ASM左乙拉西坦和奥卡西平在PSE患者中药物保留率优于传统ASM丙戊酸钠,但不同ASM对PSE的有效性是否有差别尚没有确定结论。

Objective To compare the retention rate and efficacy of different anti-seizure medications(ASM)in post-stroke epilepsy(PSE)patients.Methods 94 patients who were first diagnosed with PSE and initiated ASM monotherapy at Beijing Tiantan Hospital,Capital Medical University from May 2019 to May 2022 were collected retrospectively and followed up for 12 months.Patients were grouped according to the type of ASM they used,and the 1-year drug retention rates of different groups were compared by chi-square test.The efficacy of each ASM was assessed by a standardized monthly seizure frequency and compared through rank-sum test.Results In this study,the most commonly used ASMs in PSE patients were levetiracetam(55,63.95%),sodium valproate(23,20.93%),and oxcarbazepine(14,11.63%).In the one-year follow-up,the drug retention rate of levetiracetam was 76.36%(42/55),oxcarbazepine was 71.43%(10/14),and sodium valproate was 43.46%(10/23),the former two had a higher drug retention rate than sodium valproate,and the difference was statistically significant(χ2=7.892,4.026;P=0.05,0.045).The monthly seizure frequency was 2.0(0,4.0)on levetiracetam monotherapy,1.0(0,4.0)on oxcarbazepine monotherapy,and 2.5(0,6.0)on sodium valproate,but the differences between groups were not statistically significant(P>0.05).Conclusion Novel ASM such as levetiracetam and oxcarbazepine have higher retention rate in comparison to the conventional ASM sodium valproate in patients with PSE.However,no definitive result has been reached on whether there is a difference in PSE effectiveness among ASM.