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find Keyword "抗癫痫" 60 results
  • Application of International League Against Epilepsy’ s New Consensus Definition of Drug-resistant Epilepsy in Developing Regions

    目的 评估国际抗癫痫联盟(ILAE)耐药癫痫定义专家共识在发展中国家、发展中地区应用的可行性及应用中存在的问题。 方法 2010年12月9日-2011年2月18日,连续登记癫痫专科门诊患者409例。共纳入183例患者,根据ILAE耐药癫痫新定义对每位纳入患者癫痫分类进行评估。 结果 耐药癫痫患者18例(8.7%),临床治愈患者29例(14.1%),不能判断为159例(77.2%)。入组患者共涉及癫痫药物治疗方案321项。根据ILAE定义步骤一分类为不确定的治疗方案共有199项(62.00%),其中数量最多的为服药剂量<50% WHO限定日剂量有157例(78.89%)。 结论 由于治疗剂量未能够达到国际统一标准,大量患者分类不明确,使得该共识应用面临巨大挑战,但目前为止该共识对于发展中地区耐药癫痫治疗有很强的指导促进意义,对未来耐药癫痫的早期识别有非常大的应用潜力。

    Release date:2021-06-23 07:35 Export PDF Favorites Scan
  • Gabapentin for Restless Legs Syndrome: A Systematic Review

    Objective To assess the efficacy and safety of gabapentin for restless legs syndrome (RLS). Methods Such databases as PubMed, EMbase, CENTRAL and CBM were searched for collecting the randomized controlled trials (RCTs) on the efficacy and/or tolerability of gabapentin for restless legs syndrome. Methodological quality of the trials was evaluated using the Cochrane risk-of-bias criteria, and meta-analysis was carried out using RevMan 5.1. Results Seven RCTs involving 1 163 patients which met the criteria were included, of which 4 were placebo parallel controlled trials and 3 were placebo cross-over trials. The outcomes of meta-analysis suggested that a) As to the change of RLS severity based on IRLSSG score, gabapentin was superior to placebo in alleviating the severity of RLS (MD= –3.24, 95%CI –4.40 to –2.09, Plt;0.000 01); b) As to the response rate based on investigator-rated CGI-I scale, it was higher in the gabapentin group (77%) compared with that in the placebo group (50%) (RR=1.81, 95%CI 1.54 to 2.11, Plt;0.000 01); c) As to quality of sleep, gabapentin was superior to placebo in reducing sleep disturbance (MD= –11.31, 95%CI –14.46 to –8.16), assuring quality of sleep (MD= 0.27, 95%CI 0.10 to 0.44) and alleviating daytime somnolence (MD= –3.96, 95%CI –6.42 to –1.50); and d) As to the RLS pain score, gabapentin was better in relieving pain compared with placebo (MD= –0.97, 95%CI –1.47 to –0.47). In addition, main side effects were somnolence (3.1% to 26.5%) and dizziness (2.1% to 19.5%), and there was a significant difference between two groups. Conclusion Gabapentin can effectively alleviate RLS patients’ condition, improve quality of sleep, relieve pain and show good tolerability.

    Release date:2016-09-07 10:59 Export PDF Favorites Scan
  • The Retention Rate of New Antiepileptic Drugs in Treating Adults with Generalized Tonic-clonic Seizure

    目的 比较5种新一代抗癫痫药物对成人全面强直阵挛发作单药治疗的保留率。 方法 选择2010年7月-2011年6月354例确诊为癫痫全面强直阵挛发作患者,分别采用拉莫三嗪、左乙拉西坦、奥卡西平、托吡酯、加巴喷丁5种药物进行单药治疗,对其5种药物的6、12个月保留率进行比较。 结果 5种药物的6、12个月保留率分别为:拉莫三嗪90.8%、79.8%,左乙拉西坦88.0%、66.7%,奥卡西平82.1%、58.2%,托吡酯81.2%、58.0%,加巴喷丁26.5%、20.6%。6个月保留率加巴喷丁与其他4种药物比较差异有统计学意义(P<0.001),其他药物之间差异无统计学意义。12个月保留率拉莫三嗪与其他4种药物比较差异有统计学意义(P<0.005),其他药物之间差异无统计学意义。 结论 拉莫三嗪对成人全面强直阵挛发作单药治疗12个月保留率最高。通过对5种新一代抗癫痫药物12个月保留率比较研究,可以对临床单药治疗癫痫药物选择提供一定参考。

    Release date:2016-09-08 09:16 Export PDF Favorites Scan
  • Analysis of the factors of recurrence after discontinuation of antiepileptic drugs in the first year in children with idiopathic epilepsy

    ObjectiveTo observe the children with idiopathic epilepsy who received AED therapy and seizure-free, withdrawal at least 1 year, and analyze the risk factors of seizure recurrence. In order to give better instructions for AED withdrawal of children with idiopathic epilepsy in pediatric department. MethodsChildren with idiopathic epilepsy who were seizure-free and had stopped AED treatment at least 1 year before the deadline of observation were collected from pediatric outpatient and inpatient department of the First Affiliated Hospital of Guangxi Medical University from January 2011 to January 2014. The following variables, derived from the case records were analyzed: sex, age at seizure onset, type of seizure, time period between the onset of the first seizure and start of treatment, number of seizures in the time period between the start of AED therapy and the last seizure, number of AEDs before remission, time period between the start of AED therapy and the last seizure, time period between the last seizure and withdrawal of AED treatment (seizure-free period, timing of AED withdrawal), time period between the start of AED withdrawal and total discontinuation(speed of withdrawal), EEG registered at the time of diagnosis, before AED withdrawal, during and after AED withdrawal, and the condition of recurrence, data analysed by multi-variate step-wise Cox regression model analysis. ResultsA total of 16(12.8%) children relapsed in a total number of 125 children with idiopathic epilepsy we collected; date evaluated by multi-variable analysis showed that the children suffering from seizure type of focal seizure, starting withdrawal after a seizure-free period of less than 3 years and with abnormal post-withdrawal EEG recording was associated with a higher risk of seizure recurrence. ConclusionsChildren with idiopathic epilepsy have a low risk of recurrence after AED withdrawal. Those who suffer from seizure type of focal seizure, start withdrawal after a seizure-free period of less than 3 years and with abnormal post-withdrawal EEG recording are associated with a higher risk of seizure recurrence.

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  • 抗癫痫药物与自杀的关系——国际抗癫痫联盟治疗方法委员会手术治疗协作组报告

    在2008年, 美国食品及药品管理局(Food and drug administration, FDA)警告医务工作者关于接受抗癫痫药物(AEDs)治疗的患者自杀观念及自杀行为的风险均有增高。自此以后, 一系列回顾性队列研究及病例对照研究均致力阐明这一议题, 但不同研究的结果却相互矛盾。这是一份来自国际抗癫痫联盟(ILAE)神经心理生物学工作组的专家共识。尽管部分(并非全部)AEDs与治疗中出现的自杀观念与自杀行为相关(目前预计风险很低), 但仍需要进一步评估。此外, 停止AEDs治疗或拒绝开始AEDs治疗会明显加重病情, 带来严重后果甚至引起患者死亡。癫痫患者的自杀问题是多因素的, 不同的变量在其中发挥作用。临床医生应当注意观察并选用合适的筛查工具评估患者是否存在自杀的风险。必要时应当推荐患者去看精神科医师, 即使患者出现自杀倾向也不应当停用AEDs。当启用一种新的AED治疗或替换AED时, 应注意询问患者近期是否有情绪的改变或出现自杀观念。关于治疗时出现的精神异常事件等资料应被记录, 不仅仅记录治疗相关的安全信息, 还应记录对照研究的信息, 在患者开始新的AED治疗时告知患者及家属新药上市的时间

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  • 癫痫持续状态研究进展

    从国内外研究现状出发, 对癫痫持续状态(Status epilepticus, SE)的定义、流行病学和病因、发病机制、分类、诊断评估、治疗及预后等进行了全面阐述。有关SE定义的历史变迁, 从理论性定义到实用性定义均给出了明确界定, 其中实用性定义为适应人们对SE病理生理机制的进一步理解和满足临床容易操作需要不断更新。国际抗癫痫联盟(ILAE)已对强直-阵挛SE、复杂部分发作SE和失神SE实用性定义给出了明确规定。并对SE的流行病学及病因进行了探讨, 多种神经系统及全身性病理生理改变可导致SE, 发作自我维持与自我终止的平衡破坏是SE发生的必要条件, 发作导致神经系统兴奋性和抑制性系统失衡, 后者反过来又促进发作持续。有关SE分类一直备受关注, 几经变迁, 最新方案重新按惊厥性和非惊厥性分为两大类。诊断需依靠脑电图监测, 尤其非惊厥类型, 典型癫痫发作且持续时间足够长, 可无需脑电图监测证据。神经影像及实验室检查有助于发现病因。SE为神经科急症, 尽早控制发作, 并应与详细的病史采集同时进行, 院前积极给药明显增加SE控制率, 咪达唑仑和苯二氮卓类为首选药物。对难治性SE及早应用麻醉药物, 可减少并发症及死亡率, 提高控制率

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  • Clinical and EEG features associated with refractoriness in benign childhood epilepsy with centrotemporal spikes

    ObjectiveThe aim of this study is to identify clinical and electroencephalographic features associated with refractoriness to the initial antiepileptic drug in typical benign childhood epilepsy with centrotemporal spikes (BECTS). MethodsA total of 87 children with typical BECTS were retrospectively reviewed in the analyses.The patients were subdivided into two groups:patients whose seizures were controlled with monotherapy, and those requiring two medications. 63 childrenachieved seizure-freedom with monotherapy, while 24 received two medications for seizure control. ResultsDiffusing foci at the follow-up EEG and delayed treatment (duration > 1 year) are two main risk factors associated with more refractory cases (P < 0.001). Delayed diagnosis (37.1%) and non-adherence to treatment (57.2%) contributed to delayed treatment. ConclusionsOur findings suggested that diffusing foci on EEG and delayed treatment are associated with more frequent seizures and refractoriness in BECTS. Diagnostic delays and non-adherence hindered timely care, which may represent opportunities for improved intervention.

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  • Clinical analysis of benign childhood epilepsy with centrotemporal spikes

    ObjectiveUsing retrospective study to analyze the data of 112 patients with benign childhood epilepsy with centrotemporal spikes (BECTS) and investigate the clinical characteristics and provide some clinical experience in treatment. MethodsWe collected the medical records of 112 cases of BECTS children in the First Affiliated Hospital of Guangxi Medical University of children's clinics from January 2011 to December 2012. According to whether taking antiepileptic drugs (AEDs) treatment regularly, the 112 cases with BECTS was divided into the treated group and the non-treated group, then analyzed the clinical characteristics between the two groups retrospectively, including age of onset, single episode duration, frequency of seizure, pattern of seizure and EEG performances. ResultsThrough regular AEDs treatment, the duration of a single attack was shortened, generalized tonic-clonic seizure(GTCS) was decreased significantly in the treatment group (P < 0.05). For patients whose seizure frequency was≥3 times/3 months, AEDs could effectively control or reduce their seizure frequency (P < 0.05), while AEDs had no obvious effect on the seizure frequency of those whose seizure frequency was≤2 times/3 months (P > 0.05). In the treatment group, 29 cases whose age < 7 controlled their epilepsy attacks after taking AEDs for average of 13.76 months, while 35 cases whose age≥7 controlled their epilepsy attacks after taking AEDs for average of 6.36 months. Conclusion①BECTS patients with a long duration of a single attack and seizure frequency more than 3 times/3 months could be effectively controlled after receiving early AEDs treatment.②The younger age of onset (< 7 years old) required longer AEDs treatment to control seizures.

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  • Genetic predictors of carbamazepine and lamotrigine induced Stevens-Johnson syndrome and toxic epidermal necrolysis

    ObjectiveThe aim of this study was to investigate the pathogenesis of AED-induced SJS/TEN across the spectrum of HLA-A, -B and -DRB1 alleles, and to explore the different clinical characteristics of patients with and without the HLA-B*15:02 allele in the SJS/TEN group. MethodsA total of twenty-three patients exhibiting AED-induced SJS/TEN (16 CBZ-SJS/TEN, seven LTG-SJS/TEN) and fifty-two patients who exhibited tolerance to AEDs were recruited. High-resolution HLA genotyping was performed to estimate the prevalence of the HLA-A, -B and -DRB1 alleles for each subject. Patients in the SJS/TEN group were further divided to positive HLA-B*15:02 allele group and negative HLA-B*15:02 allele group depending on whether carrying the HLA-B*15:02 allele, and the clinical feathers were compared between the two groups. ResultsNine of twenty-three patients (39%) in the SJS/TEN group were male, and the mean age of this group was 32 (8-68) years old. Twenty-eight of fifty-four (54%) patients in the tolerant group were male, and the mean age of the tolerant group was 28 (9-64) years old.Fourteen subjects in the SJS/TEN group carried the HLA-B*15:02 allele, whereas only four subjects (7.7%) in the AED-tolerant group carried this allele; the carrier rate of HLA-B*15:02 was significantly different between the groups (P<0.001). Among the fourteen patients who carried the HLA-B*15:02 allele in the SJS/TEN group, composing the positive HLA-B*15:02 allele group, eight patients (57.1%) were female, whereas six of nine patients in the negative HLA-B*15:02 allele group were female. The difference of the gender didn't have statistical significance between the two groups, nor did the other clinical characteristics, including mean age, the dosage of the AEDs, the interval from the drug administration to the onset of the SJS/TEN, fever, allergic history, abnormal MRI and abnormal EEG results. ConclusionsThe pathogenesis of AED-induced SJS/TEN is a complex process, which may involve one or more alleles. The HLA-B*15:02 allele may be a genetic susceptibility factor of the AED-induced SJS/TEN. However, we didn't find significant difference of the clinical characteristics of SJS/TEN between the patients with and without the HLA-B*15:02 allele. Notably, further studies using larger samples are required to confirm these conclusions.

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  • 新型抗癫痫药物在控制孕期痫性发作的效能

    评估新型抗癫痫药物(AEDs)——拉莫三嗪、托吡酯与左乙拉西坦在患者妊娠期中控制痫性发作的效能。分析在澳大利亚登记数据库中应用AEDs控制痫性发作的癫痫患者中1 534例次患者妊娠的数据。在澳大利亚癫痫登记的数据中,接受单种AED治疗的1 111例次妊娠的患者中,妊娠期使用左乙拉西坦控制发作的患者的痫性发作控制率与服用传统AEDs如卡马西平、丙戊酸的发作控制率相近;优于拉莫三嗪、托吡酯在孕期的发作控制率。左乙拉西坦作为控制癫痫患者的妊娠期发作的药物有应用前景。

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