丙戊酸和拉莫三嗪治疗儿童失神癫癎的临床研究

Valproic acid versus lamotrigine as a monotherapy for absence epilepsy in children

摘要:

目的：评价丙戊酸和拉莫三嗪单药治疗儿童失神癫癎的临床疗效。方法：通过典型临床表现和视频脑电图（过度换气诱发实验阳性）确诊儿童失神癫癎，将患者进行随机开放对照分组研究。分别给予丙戊酸和拉莫三嗪单药治疗，随访1年，观察患者的发作控制情况，脑电图的改善以及不良反应。结果：共有48例入组，45例患者完成观察，其中丙戊酸治疗组23例，拉莫三嗪治疗组22例。丙戊酸组在服药12月时有17例实现无发作，其中15例脑电图无癎样放电。拉莫三嗪组在服药12个月时12例无发作（P＞0.05），其中6例脑电图无癎样放电（P＜0.05）。所有患者均未见严重不良反应。结论：丙戊酸和拉莫三嗪均为治疗儿童癫癎的安全有效药物；丙戊酸控制癎样放电可能优于拉莫三嗪。［中国当代儿科杂志，2009，11（8）：653-655］

Abstract:

OBJECTIVE: To compare the efficacy of valproic acid (VPA) and lamotrigine as a monotherapy for absence epilepsy in children.MethodsA randomized, open-label design was used. Childhood absence epilepsy was diagnosed based on the presence of typical seizures and video-EEG findings. Eligible patients were randomly treated with VPA or lamotrigine. All patients were followed up for 12 months. RESULTS: Forty-five out of 48 eligible children completed the study. There were 23 children in the VPA group and 22 children in the lamotrigine group. Seventeen children were seizure-free in the VPA group 12 months after treatment. Fifteen out of the 17 children showed normal EEG (no epileptic-formed discharge). Twelve children were seizure-free in the lamotrigine group 12 months after treatment. The proportion showing normal EEG in the camotrigine group (6/22, 27.3%) was significantly lower than that in the VPA group (15/23, 65.2%) (P<0.05). Severe adverse effects were not found in both groups. CONCLUSIONS: Both VPA and lamotrigine are safe and efficacious for treatment of absence seizures in children. VPA appears to be better than lamotrigine in tapering epileptic-formed discharge.［Chin J Contemp Pediatr, 2009, 11 (8):653-655］