丙戊酸钠、奥卡西平与左乙拉西坦分别治疗小儿癫痫的疗效及对认知功能的影响

目的 探讨丙戊酸钠、奥卡西平与左乙拉西坦分别治疗小儿癫痫的疗效及对小儿认知功能的影响。方法 收取2011年4月—2016年1月于渭南市妇幼保健院进行治疗的癫痫患儿96例作为研究对象,根据随机数字表法将其分为A、B、C组,每组各32例,分别使用丙戊酸钠、奥卡西平或左乙拉西坦进行治疗,3组患儿均治疗16周。对3组患儿临床疗效、脑电变化情况、认知功能变化情况以及用药安全性进行观察与比较。结果 A、B、C组治疗总有效率分别为71.88%、78.13%、90.63%,C组高于A、B组,但三组间比较无统计学差异。随治疗时间延长,3组患儿痫样放电好转率逐渐升高。C组好转率高于B组更高于A组,组间比较差异均有统计学意义（P＜0.05）。3组患儿治疗前语言智商（VIQ）、操作智商（PIQ）及总智商（FIQ）均无显著差异,治疗后B、C两组均较治疗前得分显著升高,且高于同期A组得分,差异有统计学意义（P＜0.05）。A组不良反应发生率为28.13%,B组为12.50%,C组为3.13%,3组间比较差异显著（P＜0.05）。结论 丙戊酸钠、奥卡西平与左乙拉西坦单药治疗小儿癫痫疗效相当,但奥卡西平与左乙拉西坦对脑电功能及小儿认知功能改善具有更加积极的意义,且以左乙拉西坦的安全性更高,具有更好的应用价值。     

左乙拉西坦对良性癫痫伴中央-颞区棘波患儿的疗效观察及智力影响

目的 分析左乙拉西坦对良性癫痫伴中央-颞区棘波患儿的疗效观察及智力影响,为临床治疗提供科学依据。方法 选取保定市儿童医院2016年8月—2018年7月收治的60例伴中央-颞区棘波良性癫痫患儿作为研究对象,按照信封法随机分为对照组(30例)与观察组(30例),对照组采用卡马西平治疗,观察组采用左乙拉西坦治疗。比较两组的临床疗效、P300潜伏期、智力水平、视听觉刺激的注意能力以及不良反应发生率。结果 治疗后,观察组伴中央-颞区棘波良性癫痫患儿的临床总有效率高于对照组,差异有统计学意义(96.67% vs.73.33%,P＜0.05);观察组患儿治疗6个月后的P300潜伏期短于对照组,差异有统计学意义(t=3.527,P＜0.05);观察组患儿治疗后的语言智商、操作智商、总智商、视觉刺激、听觉刺激的反应控制商数、注意商数均显著高于对照组,差异有统计学意义(t=9.186、2.347、3.143、2.113、4.171、2.052、3.592,P＜0.05);两组间不良反应发生率比较,差异无统计学意义(P＞0.05)。结论 左乙拉西坦治疗能够有效控制伴中央-颞区棘波良性癫痫患儿的癫痫发作情况,对于P300潜伏期以及智力水平存在积极影响。     

左乙拉西坦治疗小儿癫痫的价值分析

目的研究左乙拉西坦治疗小儿癫痫的价值,为临床提供指导。方法选择从2017年12月—2018年12月收治的40例癫痫患儿纳入此次研究工作,按照数字随机分方式将其划分成两组,命名为实验组与对照组,各有20例。对照组接受奥卡西平治疗,实验组接受奥卡西平联合左乙拉西坦治疗,对比两组患儿临床治疗效果、不良反应发生率。结果经比较,实验组临床治疗效果比对照组高,不良反应发生率低于对照组,有明显差异,有统计学意义(P<0.05)。结论采用左乙拉西坦治疗小儿癫痫,可以不断提升临床疗效,且用药安全性较高。     

An open trial of levetiracetam for segmental and generalized dystonia.

Local botulinum toxin injections represent the treatment of choice for most patients with focal dystonia. However, patients with segmental or generalized forms require additional pharmacologic treatment which is often ineffective or limited by intolerable side-effects. An animal study and three case reports suggested antidystonic effects of levetiracetam, a pyrrolidone derivate, whereas a recent open-label study found no improvement in 10 patients with primary idiopathic cervical dystonia. We studied the efficacy of levetiracetam in a daily dose of 3000 mg in 10 consecutive patients with otherwise therapy refractory segmental or generalized dystonia. At 4-week follow-up, none of the patients showed improvement of dystonia, mild side-effects were observed in 3 patients.     

UHPLC-MS/MS测定人血浆中4种一线抗癫痫药物浓度及其临床应用

目的 建立对人血浆中丙戊酸钠、卡马西平、拉莫三嗪和左乙拉西坦浓度测定的超高效液相-串联质谱方法，并进行临床实际运用。方法 血浆样本甲醇沉淀蛋白后，采用Waters Acquity UPLC BEH C₁₈色谱柱(100 mm×2.1 mm，1.7 μm)，流动相为0.1%甲酸水-乙腈，梯度洗脱，进样1 µL。选择正负离子同时监测模式分析，卡马西平、左乙拉西坦、拉莫三嗪、丙戊酸钠、替硝唑(内标)MRM通道分别为m/z 236.9→193.9，m/z 171.0→154.2，m/z 256.0→145.0，m/z 143.1→143.1，m/z 248.1→120.9；去簇电压和碰撞电压分别为70 V/21 V，90 V/10 V，90 V/23 V，–50 V/–10 V，90 V/42 V。结果 血浆样本中各代谢物丙戊酸钠(线性范围20~150 µg·mL^-1)、卡马西平(线性范围2~15 µg·mL^-1)、拉莫三嗪(线性范围0.5~15 µg·mL^-1)、左乙拉西坦(线性范围2~60 µg·mL^-1)在该方法下呈良好的线性关系，r²>0.997，血浆样品中各待测物的精密度与准确度试验均符合要求(RSD<6.7%，−12.9%<准确度<10.5%)。共收集77例2021年1月—2021年6月临床癫痫患者服药后血浆进行药物浓度检测分析，丙戊酸钠、卡马西平、拉莫三嗪和左乙拉西坦浓度治疗窗合格率分别是69.57%，70.00%，87.50%和36.11%。结论 本方法适用于临床上大样本量分析，为临床医技部门治疗药物浓度检测提供了一个便捷、可靠、科学的检测手段。     

左乙拉西坦添加治疗肌阵挛-失张力癫癇4例报道

目的：探讨左乙拉西坦添加治疗肌阵挛-失张力癫癇（MAE）的有效性及安全性。方法：回顾分析4例左乙拉西坦添加治疗的MAE病例,并结合国外相关文献分析其有效性和安全性。结果：4例MAE患者添加左乙拉西坦治疗后癫癇发作均明显减少,其中3例完全无发作,最长无发作时间达6个月,并且无明显不良反应。结论：左乙拉西坦添加治疗MAE可能是一较好的治疗方案。     

The safety of levetiracetam

Levetiracetam is an antiepileptic drug approved for use as an adjunct agent in partial-onset seizures in adults and children aged ≥ 4 years. It was also approved as adjunctive therapy in the treatment of adults and adolescents aged ≥ 12 years with juvenile myoclonic epilepsy. A parenteral intravenous formulation has recently become available allowing for its use when oral administration is temporarily not feasible. Available literature has demonstrated and supported that levetiracetam has an acceptable safety profile and this review discusses the safety profile of levetiracetam, with attention to special populations. The most common adverse effects are somnolence, asthenia and dizziness, which usually appear early after initiation of levetiracetam therapy and generally resolve without medication withdrawal. The most serious adverse effects are behavioral in nature and are more common in children and in patients with a prior history of behavioral problems.     

Treatment of tardive dyskinesia with levetiracetam in a transplant patient

Objective –  To describe successful treatment of tardive dyskinesia with levetiracetam.
Background –  Tardive dyskinesia is a late-onset movement disorder caused by exposure to dopamine receptor blocking agents, most commonly neuroleptics. Metoclopramide is frequently used to treat gastrointestinal dysmotility. It has antidopaminergic properties, and is estimated to be responsible for two-thirds of drug-related movement disorders.
Design/methods –  Case report.
Results –  A 68-year-old woman presented with a history of intestinal transplantation (12 years ago; short gut syndrome related to bowel resection for rectal carcinoma) and renal transplantation (1 year ago; diabetes). She developed involuntary movements with stereotypic oro-buccal-lingual dyskinesias and right-sided choreiform movements. Her Abnormal Involuntary Movement Scale score (AIMS) score was 27. She has been treated with metoclopramide for gastrointestinal dysmotility for more than 10 years and was diagnosed with tardive dyskinesia. Treatment with levetiracetam 250 mg orally b.i.d. led to a significant improvement of abnormal movements within a week. Her AIMS score decreased to 8.
Discussion –  Tardive dyskinesia may be quite disabling and options include withdrawal of offending medication, or use of tetrabenazine or reserpine. Several reports also suggested improvement of tardive movement disorders with levetiracetam. In our patient, levetiracetam relieved symptoms of tardive dyskinesia and allowed continuous use of metoclopramide. Larger studies are needed to confirm its efficacy.     

Clinical predictors in patients with refractory epilepsy exposed to levetiracetam: a single-center study

Objectives –  This aim of the study was to ascertain the importance of clinical parameters on the response to treatment in refractory epilepsy patients on levetiracetam (LEV).
Materials and methods –  We retrospectively evaluated medical records of 132 patients aged 17–78 years with refractory epilepsy (defined as a failure of at least two antiepileptic drugs due to the lack of efficacy) exposed to LEV. We analyzed the response (seizure freedom or continuing LEV) using logistic regression.
Results –  Of 132 patients exposed to LEV, 103 cases continued the drug. Of the discontinuations (29/132), 75% were for lack of efficacy and 25% for tolerability problems. Twenty-three percent of the previously refractory patients achieved seizure freedom for at least 1 year with LEV in combination therapy. The dose of LEV in 80% of seizure-free patients was 1000 mg/day or less. The duration of epilepsy, age and sex were not associated with response to LEV. Seizure freedom was associated with epileptic syndrome or etiology. If no specific syndrome was recognized, there was a significantly greater chance for response compared with temporal lobe epilepsy (OR 20.76; 95% CI 2.12–203.61).
Conclusions –  Our study was based on the careful clinical evaluation of the patients with extensive use of video EEG (50%) and MRI scans (95%). These clinical predictors were evasive in previous studies. This study showed that they are worth pursuing but significantly larger groups of patients need to be investigated to reach significant findings.     

The long term retention of levetiracetam in a large cohort of patients with epilepsy

Levetiracetam (Lev) is a new antiepileptic drug with a distinct mechanism of action, shown in regulatory trials to be effective. These controlled trials do not always predict how useful a drug will be in day to day clinical practice. Retention rates can provide a better indication of efficacy and tolerability in everyday use. Patients attending a tertiary referral centre for epilepsy and who received Lev in the first 2 years of its marketing were assessed (n = 811) to determine continuation rates of treatment with this drug. At the last follow up, 65% of patients were still taking Lev, and the estimated 3 year retention rate was 58%. In total, 11% attained seizure freedom of at least 6 months. Patients taking greater numbers of concurrent antiepileptic drugs (AEDs) were more likely to discontinue Lev, and those reaching higher maximum daily dosages were less likely to discontinue Lev. The retention rate for Lev compares favourably with that of other new AEDs.