左乙拉西坦与拉莫三嗪治疗新诊断小儿癫痫疗效及对认知功能影响的对比研究

袁圣勇 袁莉 潘北香

【摘要】 目的 比较分析两种新型抗癫痫药左乙拉西坦与拉莫三嗪治疗新诊断儿童癫痫疗效及对认知功能的影响， 为临床儿童抗癫痫治疗提供一定的理论指导。方法 80例新诊断癫痫患儿， 随机分为左乙拉西坦组和拉莫三嗪组， 各40例。左乙拉西坦组给予左乙拉西坦治疗， 拉莫三嗪组给予拉莫三嗪治疗。比较两组临床疗效、不良反应发生情况及精神状态检测量表（MMSE）评分。结果 左乙拉西坦组的总有效率为97.5%， 拉莫三嗪组的总有效率为92.5%， 两组比较差异无统计学意义（P>0.05）。两组药物治疗期间， 左乙拉西坦组的不良反应发生率为7.5%， 明显低于拉莫三嗪组的25.0%， 差异有统计学意义（P<0.05）。治疗前及治疗后3、6个月， 两组的MMSE评分比较差异均无统计学意义（P>0.05）。结论 两种新型抗癫痫药左乙拉西坦和拉莫三嗪治疗新诊断儿童癫痫的临床疗效及对认知功能的影响没有明显的差异， 但左乙拉西坦的不良反应明显少于拉莫三嗪， 因此左乙拉西坦的总体效果要优于拉莫三嗪。

【关键词】 左乙拉西坦;拉莫三嗪;儿童癫痫;认知功能

DOI：10.14163/j.cnki.11-5547/r.2019.19.048

【Abstract】 Objective   To compare and analyze the efficacy of two new antiepileptic drugs of levetiracetam and lamotrigine in the treatment of newly diagnosed pediatric epilepsy and their effects on cognitive function， so as to provide some theoretical guidance for clinical antiepilepsy. Methods   A total of 80 newly diagnosed epilepsy children were randomly divided into levetiracetam group and lamotrigine group， with 40 cases in each group. Group A was treated with levetiracetam， and group B was treated with lamotrigine. Comparison were made on clinical efficacy， occurrence of adverse reactions and mini-mental state examination （MMSE） scores in two groups. Results   Levetiracetam group had total effective rate as 97.5%， and lamotrigine group had total effective rate as 92.5%， and the difference was not statistically significant （P>0.05）. During drug therapy， levetiracetam group had lower incidence of adverse reactions as 7.5% than 25.0% in lamotrigine group， and the difference was statistically significant （P<0.05）. Before treatment and after 3 and 6 months of treatment， both groups had no statistically significant difference in MMSE score （P>0.05）. Conclusion   There is no significant difference in the clinical efficacy and cognitive function between two new antiepileptic drugs of levetiracetam and lamotrigine in the treatment of newly diagnosed pediatric epilepsy， but the adverse reaction of levetiracetam is significantly less than that of lamotrigine， so the overall effect of levetiracetam is better than that of lamotrigine.

【Key words】 Levetiracetam; Lamotrigine; Pediatric epilepsy; Cognitive function

癲痫（epilepsy）是一种由大脑神经元细胞反复异常放电引起以脑功能异常为特点的慢性疾病， 其中一半以上的癫痫患者在儿童时期发病。癫痫目前主要以药物治疗为主， 儿童癫痫治疗与成人的癫痫治疗有明显的不同， 在儿童癫痫的治疗过程中， 选择疗效明显、不良反应轻微并且依从性好的抗癫痫药物进行治疗显得更为重要。但是关于儿童抗癫痫治疗方案国内外尚无统一标准， 现有的儿童抗癫痫药物的使用方法大多来自于成人抗癫痫治疗研究的简单延伸。左乙拉西坦、拉莫三嗪均为临床常用的新型抗癫痫药物， 前者作用机制主要通过与突触囊泡蛋白SV2A结合调节神经递质的释放而发挥抗癫痫作用[1]， 具有广谱抗癫痫活性， 起效速度快、安全性高、患儿耐受性佳[2]， 后者可通过阻滞钠通道， 稳定细胞膜， 阻止兴奋神经介质释放， 对部分性发作癫痫疗效较好[3]。本文主要研究左乙拉西坦与拉莫三嗪治疗新诊断儿童癫痫疗效及对认知功能的影响， 为临床儿童抗癫痫治疗提供一定的理论指导。现报告如下。