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目的观察拉莫三嗪(LTG)对丙戊酸类药物治疗无效的各种类型癫的疗效及安全性。方法选择64例单独使用丙戊酸类药物(VPA)治疗至少3个月而未能有效控制癫发作的癫患儿,应用LTG替换治疗。在8周的加量期VPA用量不变,LTG以0.2~0.5 mg.kg-1.d-1为初始剂量,每隔1~2周增加1次剂量,逐渐添加至治疗剂量,VPA按每2周减用原剂量1/4逐渐减量至停用,维持治疗12周。观察LTG加量期和维持期各种类型癫发作的控制情况,计算其总有效率。结果 64例患儿中,11例在使用LTG加量期得到控制,16例发作频率减少≥50%,发作频率减少<50%和发作未控制共37例,总有效率为42.2%。23例在维持期发作完全控制,13例发作频率减少≥50%,发作频率<50%和发作未控制共28例,总有效率为56.2%。加量期与维持期总有效率比较差异无统计学意义(P>0.05)。不良反应包括皮疹4例,嗜睡2例,头晕1例。结论 LTG对于VPA治疗无效的癫患儿疗效显著,且不良反应少。
Objective To observe the efficacy and safety of lamotrigine (LTG) in treating various types of epilepsy with valproic acid therapy. Methods Sixty-four children with epilepsy who were treated with valproate alone (VPA) for at least 3 months without effective control of epileptic seizures were treated with LTG replacement therapy. The dosage of VPA remained the same at 8 weeks, and the dose of LTG was increased by 0.2 ~ 0.5 mg.kg-1.d-1 every 1 ~ 2 weeks and gradually increased to the therapeutic dose. VPA was 2 weeks to reduce the original dosage of 1/4 tapering to disable, maintain treatment for 12 weeks. Observe LTG plus period and maintenance of various types of epileptic seizures control, calculate the total effective rate. Results Of the 64 children, 11 were controlled by the use of LTG, with a reduction of seizure frequency of ≥50% in 16 patients, a reduction of seizure frequency of <50% and uncontrolled seizures in 37 patients, with a total effective rate of 42.2%. Twenty-three patients had complete control of episodes of seizures, 13 episodes of seizure reduction ≥50%, seizure frequency <50% and seizures uncontrolled for a total of 28 patients, with a total effective rate of 56.2%. There was no significant difference in the total effective rate between add-on period and maintenance period (P> 0.05). Adverse reactions, including rash in 4 cases, drowsiness in 2 cases, 1 case of dizziness. Conclusion LTG is effective in treating children with epilepsy who are ineffective with VPA and has few side effects.