拉考沙胺添加治疗儿童及青少年难治性癫痫的临床分析

Clinical analysis of Lacosamine supplementation in the treatment of refractory epilepsy in children and adolescents

目的观察分析拉考沙胺(Lacosamide,LCM)添加治疗儿童及青少年难治性癫痫的疗效及不良反应。方法回顾性分析2020年1月—2023年3月在广州医科大学附属妇女儿童医疗中心神经内科诊治的难治性癫痫患者85例,其中男50例、女35例,年龄0.5~15岁,平均(6.90±3.61)岁,通过口服LCM添加治疗自身对照研究,并进行随访,对比观察使用LCM前后的疗效及不良反应。结果通过自身对照,添加LCM治疗后经过12个月的随访,相比于基线,治疗3、6、12个月后癫痫发作频率均有下降,差异具有统计学意义(P<0.05),在添加治疗3、6、12个月后分析患儿的有效率分别为36.47%、42.35%及41.18%,添加LCM治疗12个月后无发作的病例有22例,无发作率达25.88%;入组患者基线状态使用多种抗癫痫发作药物,较多患者使用的3种药物分别是丙戊酸钠54例(63.53%)、左乙拉西坦41例(48.24%)和奥卡西平24例(28.24%)。添加LCM后共有10例出现不良反应,如头晕、头痛、恶心等。不良反应发生率11.76%;添加LCM后12个月的保留率是63.5%。结论LCM添加治疗儿童及青少年难治性癫痫能有效地改善癫痫发作频率,不良反应少、保留率较高。

Objective To observe and analyze the efficacy and adverse reactions of Lacosamide(LCM)in the treatment of refractory epilepsy in children and adolescents.Methods A retrospective cohort study was conducted on 85 patients with refractory epilepsy,with 50 males and 35 females,aged 0.5~15 years with an average age of(6.90±3.61)years,who were treated in the Department of Neurology of Guangzhou Women and Children’s Medical Center,Guangzhou Medical University,from January 2020 to March 2023.A self-controlled study was conducted by oral LCM add on treatment,and follow-up was performed to compare and observe the efficacy as well as the adverse reactions before and after the use of LCM.Results By self-control,after 12 months of follow-up after addition of LCM treatment,compared with baseline,the frequency of seizures decreased after 3,6 and 12 months of treatment,the differences were statistically significant(P<0.05),and the effective rate of analysis after 3,6 and 12 months of addition of treatment were 36.47%,42.35%and 41.18%,respectively.There were 22 cases without seizure after 12 months of LCM treatment,and the seizure-free rate was 25.88%.Enrolled patients used a variety of antiseizure medications at baseline,and the three drugs used by the most patients were sodium valproate in 54 cases(63.53%),levetiracetam in 41 cases(48.24%)and oxcarbazepine in 24 cases(28.24%)respectively.After addition of LCM,a total of 10 cases experienced adverse reactions,such as dizziness,headache,nausea,etc.The incidence of adverse reactions was 11.76%.The retention rate at 12 months after adding LCM was 63.5%.Conclusions The addition of LCM in the treatment of refractory epilepsy in children and adolescents can effectively improve the frequency of seizures,with fewer adverse reactions and higher retention rates.