吡仑帕奈单药治疗对癫痫患者睡眠及认知的影响

Effect of perampanel monotherapy on sleep and cognition of epileptic patients

目的 观察第三代抗癫痫发作药物吡仑帕奈(PER)单药治疗对癫痫患者睡眠及认知的影响,为临床治疗提供新选择及指导。方法 前瞻性分析就诊于山西医科大学第一医院的青少年及成人新发癫痫患者PER单药治疗前后相关睡眠指标及认知评分的变化。纳入研究的36例患者给予PER单药治疗,起始剂量为每晚2 mg,根据患者临床发作情况每2周增加2 mg,直到达到目标剂量每晚4~8 mg,目标剂量维持至少3个月。在PER治疗前,采用匹兹堡睡眠质量指数量表(PSQI)、失眠严重指数量表(ISI)、Epworth嗜睡量表(ESS)、蒙特利尔认知评估量表(MoCA)以及简单焦虑抑郁量表(GAD-7、PHQ-9)进行基线评估。PER治疗后,进行自身对照评估。观察治疗前后癫痫患者睡眠质量及各项指标与基线相比的变化。结果 最终33例患者完成了研究。PER单药治疗后,癫痫患者的睡眠质量显著改善(P<0.05),患者ESS及ISI评分降低(P<0.05),存在失眠及日间嗜睡情况的患者的比例差异无统计学意义(P>0.05)。PER单药治疗后,患者MoCA评分升高(P<0.01),但PHQ-9、GAD-T评分差异无统计学意义(P>0.05)。结论 PER单药治疗可以改善癫痫患者的睡眠质量,显著降低ESS、ISI评分,是癫痫合并睡眠障碍患者的用药新选择。

Objective To observe the effect of the third generation anti-seizure medicine perampanel(PER)monotherapy on sleep and cognition of epileptic patients,and provide new options and guidance for clinical treatment.Methods The changes of sleep indexes and cognitive scores of adolescent and adult new-onset epilepsy patients who were treated with PER in the First Hospital of Shanxi Medical University before and after treatment were prospectively analyzed.The 36 patients included in the study were treated with PER monotherapy,with the initial dose of 2 mg per night,which was increased by 2 mg every 2 weeks according to the clinical attack of the patient until the target dose of 4~8 mg per night was reached.Then the target dose was maintained for at least 3 months.The baseline assessment was performed with Pittsburgh Sleep Quality Index(PSQI),Insomnia Severity Index(ISI),Epworth Sleepiness Scale(ESS),Montreal Cognitive Assessment Scale(MoCA)and simple anxiety and depression scale(GAD-7,PHQ-9)before PER treatment.Self-control evaluation was performed after treatment with PER.The changes of sleep quality and various indicators of epilepsy patients before and after treatment compared with baseline were observed.Results In the end,33 patients completed the study,and it was found that PER monotherapy significantly improved the sleep quality of epilepsy patients(P<0.05),and also significantly reduced the ESS and ISI scores of patients(P<0.05),but did not significantly reduce the proportion of patients with insomnia and daytime sleepiness(P>0.05).PER monotherapy had no significant effect on anxiety or depression of patients.However,PER monotherapy significantly improved the patient′s MoCA score.Conclusion PER monotherapy can improve the sleep quality of epilepsy patients and significantly reduce the ESS and ISI scores,so it is a new drug choice for epileptic patients with sleep disorders.