奥卡西平联合左乙拉西坦治疗成人颞叶癫痫患者认知功能障碍的疗效观察
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篇名: 奥卡西平联合左乙拉西坦治疗成人颞叶癫痫患者认知功能障碍的疗效观察
TITLE: Observation of Therapeutic Efficacy of Oxcarbazepine Combined with Levetiracetam in the Treatment of Cognitive Dysfunction in Adult Patients with Temporal Lobe Epilepsy
摘要: 目的:观察奥卡西平联合左乙拉西坦治疗成人颞叶癫痫患者认知功能障碍的疗效。方法:根据设定的纳入与排除标准,收集2018年1月-2019年10月在昆明医科大学第一附属医院神经内科诊治的成人颞叶癫痫患者83例,按随机数字表法分为对照组(n=39例)和观察组(n=44)。对照组患者给予奥卡西平片,初始剂量为8~10mg/(kg·d),分早、晚两次口服,然后根据患者具体情况每周增加5~10mg/(kg·d),最大剂量不超过45mg/(kg·d),以最低有效治疗剂量持续治疗3个月;观察组患者在对照组基础上加用左乙拉西坦片,起始治疗剂量为5~10mg/(kg·d),分早、晚两次口服,根据患者的病情严重程度每周增加5~10mg/(kg·d),但总剂量不超过2000mg/d,以最低有效治疗剂量持续治疗3个月。测定两组患者治疗前后的Pz位点事件相关电位P300(包括N1、P2、N2、P3波的潜伏期和P3波的波幅),进行韦氏成人智力量表[WAIS-RC,包括分析语言智商(VIQ)、操作智商(PIQ)、总智商(FIQ)评分]和临床记忆量表[CMS,转化为记忆商(MQ)分值]测试,并记录不良反应发生情况。结果:对照组患者有5例脱落,观察组有7例脱落,共有71例(对照组34例、观察组37例)完成研究。治疗前,两组患者的Pz位点P300、WAIS-RC和CMS各项指标和评分差异均无统计学意义(P>0.05)。与治疗前比较,两组患者治疗后N2、P3波潜伏期均显著缩短、P3波波幅均显著升高(P<0.05),VIQ、FIQ以及MQ评分均显著升高(P<0.05),并且观察组患者P2波潜伏期显著缩短、PIQ评分显著升高(P<0.05)。与对照组比较,观察组患者治疗后P2、P3波潜伏期的缩短程度、P3波波幅的升高程度以及VIQ、PIQ、FIQ、MQ评分的升高程度均显著增大(P<0.05)。对照组出现1例轻微皮疹、1例自感乏力,观察组出现1例恶心想吐、1例自感乏力、1例情绪不稳,但均未见严重不良反应发生。结论:奥卡西平联合左乙拉西坦可改善成人颞叶癫痫患者的认知功能障碍,且治疗效果明显优于奥卡西平单用。
ABSTRACT: OBJECTIVE:To observe therapuetic effica cy of oxcarbazepine combined with levetiracetam in the treatment of cognitive dysfunction in adult patients with temporal lobe epilepsy. METHODS :According to inclusion and exclusion criteria ,83 adult patients with temporal lobe epilepsy were collected from neurology department of the First Affiliated Hospital of Kunming Medical University during January 2018 to October 2019,and then divided into control group (39 cases)and observation group (44 cases). Control group was given Oxcarbazepine tablet with initial dose of 8-10 mg/(kg·d),morning and night ,increased by 5-10 mg/(kg·d)each week according to patient ’s condition ,the maximal dose was 45 mg/(kg·d),lasting for 3 months with the lowest effective treatment dose. Based on treatment of control group ,observation group was additionally given Levetiracetam tablet with initial dose of 5-10 mg/(kg·d),morning and night ,increased by 5-10 mg/(kg·d)each week according to the severity of disease,the total dose was not more than 2 000 mg/d,lasting for 3 months with the lowest effective treatment dose. The event-related potential P 300 at Pz site in 2 groups was measured before and after treatment (including the incubation period of N 1, P2,N2 and P 3 waves,amplitude of P 3 wave). Webster ’s Adult Intelligence Scale [WAIS-RC ,including verbal IQ (VIQ), performance IQ (PIQ),full scale IQ (FIQ)scores] and Clinical Memory Scale [CMS ,converting to memory quotient (MQ) score] were adopted. The occurrence of ADR was recorded. RESULTS :Totally 5 patients of control group and 7 patients of observation group fell off. Finally ,a total of 71 patients participated in the entire study (34 cases in control group and 37 cases in observation group ). Before treatment ,there was no statistical significance in P 300 at Pz site ,WAIS-RC and CMS between 2 groups (P>0.05). Compared with before treatment ,incubation period of N 2 and P 3 waves was shortenedsignificantly in 2 groups,and amplitude of P 3 wave wasincreased significantly after treatment (P<0.05);VIQ,FIQ and MQ scores were increased significantly (P<0.05). The incubation pe riod of P 2 wave was shortened significantly,and PIQ score was increased significantly in observation group (P< 0.05). Compared with control group ,the shortening degree of incubation period of P 2,P3 waves,rising degree of amplitude of P 3 wave and rising degree of VIQ ,PIQ,FIQ,MQ scores were more bigger after treatment in observation (P<0.05). In the control group,there was 1 case of slight rash ,1 case of conscious asthenia ;in the observation group ,there was 1 case of nausea and vomiting,1 case of conscious asthenia ,and 1 case of emotional instability ;no serious ADR was found in 2 groups. CONCLUSIONS:Oxcarbazepine combined with levetiracetam can improve cognitive dysfunction in adult patients with temporal lobe epilepsy ,and the treatment effect is significantly better than oxcarbazepine monotherapy.
期刊: 2020年第31卷第13期
作者: 李欣潞,许虹,梁稀
AUTHORS: LI Xinlu,XU Hong,LIANG Xi
关键字: 奥卡西平;左乙拉西坦;颞叶癫痫;认知功能障碍;成人
KEYWORDS: Oxcarbazepine;Levetiracetam;Temporal lobe epilepsy ;Cognitive d ysfunction;Adult
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