大剂量激素冲击治疗57例难治性癫痫的疗效观察

Therapeutic effect of high dose hormone on 57 intractable epilepsy

目的探讨激素冲击治疗难治性癫痫的疗效,为难治性癫痫患儿的诊治提供指导经验。方法 2015年9月至2016年9月收集徐州医科大学附属医院儿科收治的57例难治性癫痫患儿病例进行回顾性分析,所有病例均给予甲泼尼龙进行冲击治疗,甲泼尼龙20 mg·kg^(-1)·d^(-1),每疗程用3 d,停4 d,连用3个疗程,疗程间隔期间给予泼尼松口服2 mg·kg^(-1)·d^(-1),出院后均给予泼尼松序贯治疗,4~12周减量,总疗程4~6个月。结果本组患儿男27例,女30例,婴儿痉挛症又称West综合征30例,Lennox-Gastaut综合征6例,获得性癫痫性失语又称Landau-Kleffner综合征6例,其他难治性癫痫15例,发病年龄1个月到6岁,激素冲击治疗前9例未应用抗癫痫药物,余48例均经2种或3种抗癫痫药物治疗且发作控制不佳。激素冲击治疗有效率84%(48/57)。结论大剂量激素冲击治疗难治性癫痫控制效果肯定,疗效与发病年龄及病程无相关性,值得在临床上推广使用。

Objective To investigate the therapeutic effect of methylprednisolone on intractable epilepsy, and provide guidance for the diagnosis and treatment of children with intractable epilepsy. Methods The clinical data of 57 intractable epilepsy from department of pediatrics, our hospital were analyzed from September 2015 to September 2016. Methylprednisolone were given for all patients by intravenous drop infusion for three courses, which included methylprednisolone intravenous infusion for three days, followed by oral prednisone for four days every time. After three courses, prednisone 2 mg·kg-1·d-1were taken by all patients for 4 to 6 months, which were reduced after 4 to 12 weeks. Results Twenty-seven cases were male and thirty cases were female, the intractable epilepsy included 30 patients diagnosed as infantile spasm(WEST), 6 patients diagnosed as Lennox-Gastaut syndrome(LGS), 6 patients diagnosed as Landau-Kleffner syndrome(LKS), 15 patients diagnosed as other refractory epilepsy, age of onset ranged from 2 months to 6 years, 9 cases did not use antiepileptic drugs before methylprednisolone, the remaining 48 patients received 2 or 3 kinds of antiepileptic drugs which were out of control, the total effective rate of corticosteroid was 84%(48/57) for all intractable epilepsy. Conclusion Methylprednisolone is effective in the treatment of intractable epilepsy, there was no significant correlation between age and course, it is worth to be applied in clinical practice.