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目的:探讨托吡酯治疗Tourette’s综合征(TS)疗效及安全性。方法:对确诊TS患儿65例随机分为托吡酯治疗组(n=40)和对照组(n=24,予氟哌啶醇),治疗48周(两组分别有1、4例放弃治疗)。托吡酯治疗组按年龄分为幼儿组、年长儿组,按发作形式分为肢体组、头面组和混合组。TS患儿于治疗前、治疗中(4、8、24及48周)进行耶鲁抽动症整体严重度量表(YGTSS)和不良反应量表(TESS)评估。结果:①第8周末托吡酯治疗组有效率(87·5%)高于对照组(40%),(P<0·01)。托吡酯治疗组YGTSS总分低于对照组(P<0·05);减分率高于对照组(P<0·05)。第48周末,托吡酯治疗组有效率(90%)高于对照组(60%),(P<0·01)。托吡酯治疗组YGTSS总分低于对照组(P<0·01);减分率高于对照组(P<0·05)。②第24周末幼儿组有效率(95%)高于年长儿组(82·6%),(P<0·05),幼儿组YGTSS总分低于年长儿组(P<0·05);减分率高于年长儿组(P<0·05)。肢体组有效率(90%)高于混合组(54%),(P<0·05)和头面组(76·9%,P<0·05)。肢体组YGTSS总分低于混合组(P<0·05);减分率高于混合组(P<0·05)。③第8周末开始托吡酯治疗组TESS评分低于对照组(P<0·05)。结论:托吡酯能有效地治疗TS,且对年幼患儿及肢体发作患者疗效较佳,长期服用副作用相对较轻。
Objective: To investigate the efficacy and safety of topiramate in the treatment of Tourette ’s syndrome (TS). Methods: Sixty-five children with TS were randomly divided into topiramate control group (n = 40) and control group (n = 24, haloperidol) for 48 weeks . Topiramate treatment group is divided into young children group, elder children group by age, according to the attack form is divided into limb group, head group and mixed group. Children with TS were evaluated for Yale’s TSG and TESS before and during treatment (4, 8, 24 and 48 weeks). Results: At the end of the 8th week, the effective rate of topiramate treatment group (87.5%) was higher than that of the control group (40%) (P <0.01). The total score of YGTSS in topiramate treatment group was lower than that in control group (P <0.05), and the reduction rate was higher than that in control group (P <0.05). At the end of the 48th week, the topiramate treatment group was more effective (90%) than the control group (60%) (P <0.01). The total score of YGTSS in topiramate treatment group was lower than that in control group (P <0.01), and the reduction rate was higher than that in control group (P <0.05). ② The effective rate (95%) in early childhood group was higher than that in elder group (82.6%) at the end of the 24th week (P <0.05), and the total score of YGTSS in young children was lower than that of the older group (P <0.05) ); The reduction rate is higher than that of the elder group (P <0.05). The effective rate of limb group (90%) was higher than that of mixed group (54%) (P <0.05) and head group (76.9%, P <0.05). The total score of YGTSS in limb group was lower than that in mixed group (P <0.05), and the reduction rate was higher than that in mixed group (P <0.05). ③ The TESS score of Topiramate treatment group was lower than that of the control group at the end of the 8th week (P <0.05). CONCLUSIONS: Topiramate is effective in the treatment of TS and is more effective in younger children and in patients with extremities attacks, with relatively less long-term side effects.