新诊断局灶性癫痫患者药物治疗2年随访研究

发布时间：2018-04-30 21:19

本文选题：局灶性癫痫 + 抗癫痫药物　；参考：《新乡医学院》2017年硕士论文

【摘要】：背景癫痫患者中,较大部分患者为局灶性癫痫。对于新诊断的局灶性癫痫患者来说,口服药物治疗是主要治疗手段,单药控制癫痫发作是首选治疗方案,因此,药物种类的选择,尤其是初始药物的选择至关重要,可能会影响癫痫患者的预后。近十年来,随着新型抗癫痫药物在临床上的广泛使用,传统抗癫痫药物如丙戊酸和卡马西平并没有被完全取代。癫痫的药物治疗,尤其是局灶性癫痫的治疗,是一个规范而长期的过程,然而目前关于新型抗癫痫药单药治疗局灶性癫痫的证据仍不充分,在新诊断癫痫患者的首选药物上,新型抗癫痫药物与传统抗癫痫药物比较并没有绝对优势,这有待进一步研究。目的本研究比较五种常用抗癫痫药物的有效性及不良反应,以期能指导日后临床中局灶性癫痫患者的初始选药。方法本研究以新乡医学院第二附属医院神经内科2006年1月至2014年11月期间开始用药的局灶性癫痫患者为研究对象,由神经内科医师综合考虑患者情况分别应用奥卡西平(OXC)、卡马西平(CBZ)、拉莫三嗪(LTG)、丙戊酸钠缓释片(VPA)、托吡酯(TPM)单药治疗并进行至少2年的随访研究。综合多种指标评价患者的疗效、耐受性及不良反应,并对影响患者单药保留的主要因素进行分析。结果共有268例患者完成研究,分别为OXC组57例,CBZ组74例,LTG组44例,VPA组61例和TPM组32例。TPM组患者在开始服药至第一次发作时间方面、2年内持续无发作时间方面显著优于CBZ组及LTG组(P0.05)。不良反应方面,OXC的不良反应发生率显著低于其余四组(P0.05),CBZ、TPM发生率显著高于OXC、LTG、VPA(P0.05)。五组患者在有效率、无发作率、一年保留率、二年保留率方面比较,差异均无统计学意义(P0.05)。总体来说,未保留的主要原因为疗效不佳(76.8%),其次为皮疹(12.5%)。结论五种药物中,新型抗癫痫药OXC表现出最佳的疗效及耐受性。但在综合指标保留率方面,新型抗癫痫药物OXC、LTG、TPM与传统抗癫痫药物VPA、CBZ相比并无优势。既往有脑部阳性病史、影像学异常、用药前发作次数多(5)的患者,单药保留失败可能性大。
[Abstract]:Background among the patients with epilepsy, most of them are focal epilepsy. For newly diagnosed patients with focal epilepsy, oral drug therapy is the main treatment, and single drug control is the first choice of treatment. Therefore, the choice of drug type, especially the choice of initial drug, is very important. It may affect the prognosis of patients with epilepsy. In recent ten years, traditional antiepileptic drugs such as valproic acid and carbamazepine have not been completely replaced with new antiepileptic drugs. The drug therapy of epilepsy, especially the treatment of focal epilepsy, is a standard and long-term process. However, the evidence on the treatment of focal epilepsy with a new antiepileptic drug alone is still insufficient, and it is the first choice drug for newly diagnosed epileptic patients. There is no absolute superiority between new antiepileptic drugs and traditional antiepileptic drugs, which needs further study. Objective to compare the efficacy and adverse reactions of five commonly used antiepileptic drugs in order to guide the initial drug selection in patients with focal epilepsy. Methods the patients with focal epilepsy who were treated in Department of Neurology, second affiliated Hospital of Xinxiang Medical College, from January 2006 to November 2014, were studied. Patients were treated with oxacepine, carbamazepine (CBZ), lamotriazine (LTG), sodium valproate (VPAA), topiramate (TPM) respectively and followed up for at least 2 years. Objective: to evaluate the efficacy, tolerance and adverse reactions of patients by synthesizing various indexes, and to analyze the main factors that affect the retention of single drug in patients. Results A total of 268 patients completed the study. There were 57 cases in OXC group, 74 cases in LTG group and 61 cases in VPA group and 32 cases in TPM group, which were significantly better than those in CBZ group and LTG group in the time from the beginning to the first attack, the duration of no seizure within 2 years was significantly better than that in CBZ group and LTG group (P 0.05). The incidence of adverse reactions of OXC was significantly lower than that of the other four groups (P 0.05). The incidence of TPM was significantly higher than that of the other four groups (P 0.05). There was no significant difference in effective rate, no seizure rate, one year retention rate and two year retention rate among the five groups. On the whole, the main cause of unretained was poor curative effect 76. 8%, followed by rashes 12. 5%. Conclusion among the five drugs, the new antiepileptic drug OXC has the best efficacy and tolerance. But in the aspect of retention rate of comprehensive indexes, the TPM of new antiepileptic drug OXC+ LTGG has no advantage compared with the traditional antiepileptic drug VPA-CBZ. Patients with positive brain history, abnormal imaging, and more frequent episodes before medication were more likely to fail in single drug retention.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.1

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