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目的探讨左乙拉西坦(LEV)对癫患者脑电电持续状态及认知的影响。方法选取8例EEG伴有睡眠期电持续状态(ESES)的癫患儿。其中良性癫伴中央颞区棘波(BECT)7例、获得性癫性失语(LKS)1例。8例患儿均应用LEV治疗,LEV起始剂量为10 mg.kg-1,每1～2周增加10 mg.kg-1,直至目标剂量40～60 mg.kg-1。例2同时予甲泼尼龙15 mg.kg-1冲击3 d停4 d,冲击2个疗程后改为泼尼松口服。分别在治疗前及治疗2周、4周及0.5 a行视频脑电图监测。EEG疗效判断:棘慢波指数从85%减至50%以下为显效,有减少但仍在50%以上为有效,无变化为无效。并同时用韦氏儿童智力量表对这些患儿治疗前及治疗4周时进行神经心理评估。结果治疗2周,患儿临床发作均得以控制,其中5例BECT患儿EEG棘慢波完全消失,其余3例患儿EEG棘慢波电压较前降低、数量较前减少;治疗4周,所有患儿的EEG恢复正常,临床无发作,LKS患儿语言较前好转。治疗4周,患儿的语言智商、操作智商及总智商均较治疗前有明显改善。随访0.5 a,仅LKS患儿在随访2个月出现EEG恶化,且语言未完全恢复正常,余患儿病情及EEG均无反复。结论 LEV对局限性发作伴ESES的癫患者的EEG及认知有改善作用,对LKS患儿有短期疗效。
Objective To investigate the effects of levetiracetam (LEV) on the status of electroencephalogram (EEG) and cognitive status in patients with epilepsy. Methods Eight children with epilepsy were enrolled in this study. There were 7 cases of benign epilepsy with central temporal spikes (BECT) and 1 case of acquired epileptic aphasia (LKS). 8 cases of children were treated with LEV, LEV initial dose of 10 mg.kg-1, every 1 to 2 weeks increased 10 mg.kg-1, until the target dose of 40 to 60 mg.kg-1. Example 2 At the same time to methylprednisolone 15 mg.kg-1 impact 3 d stop 4 d, after two courses of impact to prednisone oral. Video EEG monitoring was performed before treatment, 2 weeks, 4 weeks and 0.5 a respectively. EEG curative effect judgments: spike-wave index decreased from 85% to below 50% markedly effective, there is a reduction but still above 50% is valid, no change is invalid. At the same time with the Wechsler Intelligence Scale for Children of these children before and 4 weeks of treatment for neuropsychological assessment. Results After 2 weeks of treatment, the clinical seizures of children were controlled. Among them, the EEG spikes and waves of 5 BECT children disappeared completely and the spikes and waves of EEG spines were decreased and the number of EEG spines was reduced compared with the previous ones. After 4 weeks of treatment, EEG in children returned to normal, no clinical seizures, LKS children better than the previous language. After 4 weeks of treatment, children’s language IQ, operation IQ and total IQ were significantly improved compared with those before treatment. After 0.5 years of follow-up, only LKS children showed worsening of EEG at 2 months follow-up, and the language did not return to normal completely. Conclusions LEV can improve the EEG and cognition of patients with epilepsy with ESES and have short-term effect on LKS.