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目的探讨左乙拉西坦(LEV)治疗儿童失神癫癎(CAE)的疗效。方法选择2008年1月-2010年12月于本院诊治的CAE患儿65例。男35例,女30例;就诊年龄5～14(7.8±3.5)岁。发病年龄3～12(7.1±3.0)岁。病程为1个月～4.3 a[(12.2±9.8)个月]。随机分为LEV组(33例)和丙戊酸钠(VPA)组(32例)。分别接受LEV及VPA治疗,LEV开始剂量为10 mg·kg-1·d-1,每周加量1次,逐渐加量至20～30 mg·kg-1·d-1,最大剂量40 mg·kg-1·d-1。VPA治疗剂量为15～40 mg·kg-1·d-1,血药质量浓度控制在50～100 mg·L-1。治疗期均为24周,观察2组发作控制的效果和药物不良反应。结果 LEV组9例(27.2%)完全控制,15例(45.5%)部分控制,总有效率72.7%;VPA组11例(34.4%)完全控制,15例(46.9%)部分控制,总有效率81.3%。2组总有效率比较差异无统计学意义(P>0.05)。2组均未出现不能耐受而中断治疗的病例,LEV组不良反应轻微,3例诉头晕,2例出现困倦、乏力;VPA组不良反应较多,5例患儿体质量明显增加,4例学习成绩明显下降。结论 LEV对大部分CAE疗效满意,且不良反应小。
Objective To investigate the efficacy of levetiracetam (LEV) in the treatment of children with absence of epilepsy (CAE). Methods 65 patients with CAE who were diagnosed and treated in our hospital from January 2008 to December 2010 were selected. There were 35 males and 30 females with a mean age of 5 to 14 (7.8 ± 3.5) years of age. The age of onset was 3 ~ 12 (7.1 ± 3.0) years old. The course of disease ranged from 1 month to 4.3 months [(12.2 ± 9.8) months]. Randomly divided into LEV group (33 cases) and sodium valproate (VPA) group (32 cases). LEV and VPA were given respectively. The initial dose of LEV was 10 mg · kg-1 · d-1, and once a week, the dose of LEV was gradually increased to 20-30 mg · kg-1 · d-1 and the maximum dose was 40 mg · kg -1 · d-1. VPA treatment dose of 15 ~ 40 mg · kg-1 · d-1, plasma concentration control in 50 ~ 100 mg · L-1. The treatment period was 24 weeks. The effects of seizure control and adverse drug reactions were observed. Results The total effective rate was 72.7% in 15 cases (45.5%) in LEV group (27.2%), and that in VPA group (34.4%) and 15 cases (46.9%). The total effective rate 81.3%. There was no significant difference in total effective rate between the two groups (P> 0.05). There were no cases of unacceptable and discontinuous treatment in both groups. The adverse reactions in LEV group were mild, dizziness in 3 cases, drowsiness and fatigue in 2 cases, and adverse reaction in VPA group. The body mass of 5 cases was significantly increased, 4 cases Academic performance decreased significantly. Conclusion LEV is satisfactory to most CAE patients and the adverse reaction is small.