钟涛高 李华

[摘要] 目的 觀察左乙拉西坦片（Levetiracetam，LEV）、托吡酯片在儿童难治性癫痫综合征（LGS）中单药与联合用药的临床治疗效果。 方法 收集我院儿科2016年6月～2018年4月的病例，将诊断为LGS的60例患儿随机分为左乙拉西坦片单药治疗组（20例）、托吡酯片单药治疗组（20例）及左乙拉西坦联合托吡酯片治疗组（20例），三组患儿分别按试验要求给予左乙拉西坦（单药）、托吡酯（单药）及左乙拉西坦（LEV）、托吡酯联合治疗，给予8周治疗后对比三组间临床疗效、脑电图棘-慢复合波指数、磁共振波谱及智力量表测试评定。 结果 联合组临床有效率达到90%（18/20），左单组临床有效率为60%（12/20），托单组临床有效率为50%（10/20），可见联合组与单药组之间差异有统计学意义（P<0.05），但单药治疗组之间无明显统计学差异（P>0.05）。且联合组患儿NAA峰值上升，脑电图棘-慢复合波指数明显下降，认知功能得以提升，具有统计学意义（P<0.05）。 结论 左乙拉西坦、托吡酯片联合治疗难治性癫痫综合征（LGS）临床疗效好，值得临床推广。

[关键词] 左乙拉西坦片;托吡酯;治疗;Lennox-Gastaut综合征;儿童

[中图分类号] R742.1          [文献标识码] A          [文章编号] 1673-9701（2019）04-0024-04

[Abstract] Objective To observe the clinical effects of levetiracetam（LEV） and topiramate tablets monotherapy and combined therapy for children with refractory Lennox-Gastaut syndrome（LGS）. Methods The cases in the department of pediatrics in our hospital from June 2016 to April 2018 were collected. The children patients diagnosed with LGS were randomly assigned to the levetiracetam monotherapy group（20 cases）， the topiramate tablets monotherapy group（20 cases）， and the levetiracetam combined with topiramate tablets group（20 cases）. Three groups of children were given levetiracetam（monotherapy）， topiramate（monotherapy）， and levetiracetam combined with topiramate respectively for intervention according to the requirements of the study. The clinical efficacy， electroencephalogram spine-slow complex wave index， magnetic resonance spectroscopy and intelligence scale test were compared among the three groups of children patients 8 weeks after treatment. Results The combined group achieved clinical efficacy rate of 90%（18/20）， the levetiracetam monotherapy group achieved clinical efficacy rate of 60%（12/20）， and the topiramate monotherapy group achieved clinical efficacy rate of 50%（10/20）. The difference between the combined group and the monotherapy group was statistically significant（P<0.05）. There was no statistically significant difference between the two monotherapy groups（P>0.05）， and the peak of NAA in the combined group was increased. The EEG spine-slow complex wave index was decreased significantly， and cognitive function was improved， which were all statistically significant（P<0.05）. Conclusion The clinical efficacy of levetiracetam combined with topiramate tablets in the treatment of LGS syndrome is favorable， which is worthy of clinical promotion.

[Key words] Levetiracetam tablets; Topiramate; Treatment; Lennox-Gastaut syndrome; Children

儿童难治性癫痫综合征（Lennox-Gastaut syndrome，LGS）是一组儿童时期常见的癫痫疾病，以年龄1～5岁患儿高发，发作形式不一，表现失神、强直等，阻碍患儿神经行为的发育。有研究提示患儿智体力将不同程度的受损，脑电图有特征性的慢-棘-慢波[1，2]。考虑目前临床应用经典抗癫痫托吡酯与新型抗癫痫药物左乙拉西坦較为广泛，但针对联合用药尚较欠缺，其疗效尚需研究，本研究特将诊断为LGS的患儿随机分为左乙拉西坦单药组（20例、下称左单组）、托吡酯单药治疗组（20例、下称托单组）与左乙拉西坦联合托吡酯治疗组（20例、下称联合组），三组患儿分别按试验要求给予左乙拉西坦（单药）、托吡酯（单药）及左乙拉西坦、托吡酯联合，治疗8周后观察三组临床疗效。……