氟桂利嗪治疗儿童癫痫共患偏头痛的有效性及安全性研究

发布时间：2018-10-29 08:15

【摘要】：背景与目的癫痫(Epilepsy, EP)是起源于大脑功能区异常放电的一种疾病,而且是小儿神经系统常见疾病,18岁以下约占全部癫痫患者的2/3,患病率为3.45%o。偏头痛(Migraine, MA)也是儿童最常见的神经系统疾病之一,在我国乃至全世界呈逐年上升趋势,大约在1%～17%,但在癫痫人群中的发病率为8.4%-23%,是癫痫最常见的共患病之一,已成为严重影响儿童癫痫预后和身心健康的一种疾病。因此控制癫痫发作的同时积极有效的治疗偏头痛具有重要意义。现阶段治疗癫痫与偏头痛的主要手段是以药物为主的综合治疗,其在提高治疗效果和提高患儿生活质量方面具有非常重要的作用。氟桂利嗪(Flunarizine, FNZ)既是预防性治疗偏头痛的一线药物,也具有抗癫痫作用,因此本研究在应用抗癫痫药物(Anti-epileptic drugs, AEDs)的基础上联合应用氟桂利嗪,观察其对癫痫共患偏头痛的有效性、安全性及耐受性。方法临床收集年龄6-13岁,符合特发性癫痫诊断标准且智力正常的患儿。记录癫痫的发病年龄、病程、类型、脑电图特点、诊断年龄、开始治疗年龄、抗癫痫药物种类、用药时间、家族史等,选取符合偏头痛诊断标准的癫痫患儿,得出癫痫共患偏头痛的共患率,然后将此人群中需要偏头痛预防性治疗的患儿待抗癫痫药物控制1个月无发作后,随机分为实验组和对照组,实验组(AF组)患儿在AEDs治疗的基础上联用FNZ；对照组(A组)仅给予AEDs治疗,在治疗开始的第3、6、12个月随访并记录各患儿偏头痛及癫痫发作情况及用药的不良反应。并将患儿应用FNZ前与治疗后第3、6、12个月偏头痛发作情况进行自身对照研究。结果共纳入选患儿433例,得出癫痫共患偏头痛52例,共患率为12%。其中符合或家属要求预防性治疗者41例,年龄8.76±2.51岁,范围6-13岁,男29例,女12例。AF组22例,A组19例,两组患儿在年龄、性别、癫痫及偏头痛的发作状况,基础用药情况等的差异无统计学意义(均P0.05)。治疗后12个月两组癫痫控制的有效率均达95%左右,差别无统计学意义(P0.05) 治疗后第3个月,AF组20/22例(90.9%)头痛缓解,明显高于A组的13/19(68.4%),差异有统计学意义(P0.05)；第6个月,AF组18/21例(85.7%)头痛缓解,高于A组的14/19(73.7%)；第12个月,AF组18/21例(85.7%)头痛缓解,高于A组的13/18(72.2%),差异均无统计学意义(P0.05)。治疗3月、6月、12个月AF组头痛平均发作频率与治疗前基线水平相比明显减少,差异有统计学意义(P0.05)；A组头痛平均发作频率与治疗前基线水平相比也减少(P0.05),但无AF组明显。治疗3月、6月、12个月AF组头痛平均持续时间与治疗前基线水平相比均减少,差异有统计学意义(P0.05)；A组头痛平均持续时间与治疗前基线水平相比也减少(P0.05),但无AF组明显。治疗后第3个月,AF组7/22例(31.8%)出现不良反应,高于A组的3/19(15.8%)；第6个月,AF组7/21例(33.3%)出现不良反应,高于A组的3/19(15.8%)；在1年的随访期,AF组7/21例(33.3%)出现不良反应,高于A组的3/18(16.7%),差异无统计学意义(P0.05)。结论 1.癫痫共患偏头痛的患病率为12%。 2.抗癫痫药控制癫痫发作的同时,小剂量使用氟桂利嗪治疗癫痫共患偏头痛疗效良好,可降低偏头痛发作频率及持续时间,并未使癫痫发作加重。 3.引起不良反应较多,不过症状多轻微,患儿均能耐受。
[Abstract]:Background and Purpose Epilepsy (EP) is a disease originating in abnormal discharge of the functional area of the brain, and it is a disease of the nervous system of the child. The prevalence rate of epilepsy is 3. 45% under the age of 18 years or under the age of 2/ 3 of all the patients with epilepsy. o. Migraine (MA) is one of the most common nervous system diseases in children. In China and even around the world, the incidence is increasing year by year, about 1% ~ 17%, but the incidence of epilepsy is 8. 4% -23%. It is the most common common disease in epilepsy. 1. It has become a disease that severely affects the prognosis and physical and mental health of children with epilepsy Therefore, it is important to actively and effectively treat migraine while controlling epileptic seizures. The main means of treating epilepsy and migraine at the present stage is the comprehensive treatment of medicine, which is very important in improving the therapeutic effect and improving the quality of life of the children. Flunarizine (FNZ) is a first-line medicine for treating migraine, and it also plays an important role in the treatment of migraine. Effectiveness, Safety and tolerance The clinical collection age is 6-13 years old, which accords with the diagnosis standard of idiopathic epilepsy. The epileptic children with epilepsy were selected according to the age, course, type, EEG characteristics, age of diagnosis, treatment age, drug type, time of medication, family history, etc. The total prevalence rate of migraine was divided into two groups: experimental group and control group after one month without attack. The experimental group (AF group) was fed with FNZ on the basis of AEDs therapy, and control group (group A) was given only to the experimental group and control group. Treatment with AEDs, follow-up at Weeks 3, 6, 12 of the start of treatment and record migraine and seizures in each child and Adverse reaction of medication, and use of FNZ before and after treatment at 3rd, 6th, and 12th month migraine attacks row self A total of 433 patients with epilepsy were included in the study of body-control study. A total of 52 patients had a total of 12% of them. Among them, 41 patients were eligible for preventive treatment according to the family's requirements, and the age was 8. 76, 2.51 years, ranging from 6 to 13. The differences of age, sex, epilepsy, migraine and basic medication were not statistically significant in 22 patients, 29 males and 12 females, 22 in AF group and 19 in group A. The effective rate of epilepsy control in 12 months after treatment was about 95%, and there was no difference. In the third month after treatment (P0.05), 20/ 22 cases (90.9%) of AF group had a headache response, significantly higher than 13/ 19 (68. 4%) of group A, and the difference was statistically significant. In the 6th month, 18 of 21 patients (85.7%) had a headache response, higher than 14/ 19 (73.7%) in group A; 12 months, 18/ 21 (85.7%) headache remission in AF group, higher than 13/ 18 (70.2%) in group A, and difference was higher than that in group A. There was no statistical significance (P 0.05). The average onset frequency of headache in group A was significantly decreased compared with baseline of treatment (P0.05). The average onset frequency of headache in group A was also decreased as compared with the baseline level before treatment. The average duration of headache in group A was lower than that before treatment (P <0.05). The average duration of headache in group A was lower than that before treatment. In the third month after treatment, 7/ 22 (30.8%) of AF group had adverse reaction, which was higher than 3/ 19 (15.8%) in group A; in the sixth month, 7/ 21 (33.3%) of AF group had adverse reaction, higher than 3/ 19 (15.8%) in group A; follow-up period of 1 year, AF Adverse reactions occurred in 7 of 21 patients (33.3%) in group A and 3/ 18 (16) higher than that in group A. 7% The difference was not statistically significant (P0.05). Conclusion 1. The prevalence of migraine in epilepsy is 12%. the onset frequency and duration of migraine can be reduced without worsening the seizure.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R742.1;R747.2

【相似文献】