托吡酯单药治疗儿童癫痫43例临床观察

目的　观察托吡酯 (TPM )单药治疗儿童各型癫痫的临床疗效及不良反应。方法　对 43例各型癫痫患者应用TPM治疗 ,TPM从小剂量开始 ,起始量体重≤ 2 0kg者为 6 2 5mg/d ,体重 >2 0kg者为 12 5mg/d ,根据抽搐控制情况调整药物剂量并观察疗效及不良反应。结果　本组控制 5例 ( 11 6%) ,显效 15例 ( 3 4 9%) ,有效2 0例 ( 4 6 5 %) ,无效 3例 ( 6 9%) ,总有效率为 93 1%。不良反应症状轻微且短暂 ,多数发生于加药期。结论　TPM单药治疗各型癫痫效果明显 ,不良反应少 ,耐受性好 ,较为安全     

托吡酯联合丙戊酸钠、氯硝西泮治疗难治性癫痫临床观察

目的探讨托吡酯联合丙戊酸钠、氯硝西泮治疗难治性癫痫的疗效。方法对符合标准的157例难治性癫痫患者给予氯硝西泮、丙戊酸钠、托吡酯。观察治疗3个月、6个月、1年、2年后的疗效和不良反应。结果治疗6个月后总有效率为75.16%,随着时间的延长疗效进入平稳期;对各种发作类型都有很好的控制作用,不良反应轻微。结论托吡酯联合丙戊酸钠、氯硝西泮治疗难治性癫痫疗效确切,安全性高。     

托吡酯治疗各型癫痫的临床疗效观察

目的：观察及评价托吡酯对各型癫痫的临床疗效及安全性。方法：对2000年1月至2002年12月在该院确诊的105例癫痫患者中的72例采用托吡酯添加治疗、33例单药治疗，经8周加量期和12周稳定期观察后进行评价。结果：添加治疗组及单药治疗组总有效率分别为72．2％和84．8％，完全控制率分别为27．8％和45．5％。无明显不良反应。结论：托吡酯是一种广谱、有效及安全的新型抗癫痫药。     

托吡酯与卡马西平治疗老年癫痫的疗效比较

目的:观察比较托吡酯与卡马西平治疗老年癫痫的临床效果。方法:将2014年2月~2015年2月我院纳入的80例老年癫痫患者分为对照组与观察组,每组40例。对照组给予卡马西平口服治疗,观察组则采用托吡酯口服治疗。比较两组疗效,统计用药结束后3、6个月时癫痫发作次数。结果:观察组治疗总有效率95.0%,较对照组明显更高,组间差异具有统计学意义(P0.05)。与对照组相比,用药结束后3、6个月观察组患者的癫痫发作次数更少(P0.05)。对照组中不良反应发生率27.5%,明显高于观察组的10.0%(P0.05)。结论:在老年癫痫患者临床用药中,托吡酯疗效确切,可有效控制患者癫痫发作次数,安全性高,值得推广应用。     

托吡酯附加治疗难治性癫痫38例临床分析

目的 探讨托吡酯对难治性癫痫的治疗价值及其安全性。方法 采用每周增药一次的试验方法，观察了该药对38例难治性癫痫病人的疗效和安全性。结果 加用托吡酯2个月、4个月后总有效率分别为73．7％、78．9％；服用托吡酯对原用的抗癫痫药物血浓度无影响；1例因过敏而停药，14例有不同程度的副作用，2例需对症处理，12例自行缓解。结论 托吡酯作为附加治疗难治性癫痫有较好的疗效及耐受性。     

托吡酯单药及转换单药治疗癫痫30例疗效观察

目的 :研究应用托吡酯单药治疗各类型癫痫的疗效。方法 :采用开放性试验对 30例部分性发作及全面性发作的癫痫病人使用托吡酯单药治疗。本研究包括 8周的加量期 ,8周的稳定观察期。在加药期 ,成人剂量为托吡酯 2 5mg/d起 ;儿童加量期为服用托吡酯 1mg·kg-1·d-1起 ,直到目标剂量 (成人 2 0 0mg/d ,儿童 4～ 8mg·kg-1·d-1)或癫痫发作得到控制 ;其后为 8周维持稳定观察期。结果 :经 16周的观察显示 :总计有效率 ,癫痫发作减少≥5 0 %者为 2 7例 ( 90 % ) ,≥ 75 %者为 2 4例 ( 80 % ) ,完全控制率达 5 6 67%。就发作类型而言 ,单纯性部分性发作、复杂性部分性发作癫痫及全身强直 -阵挛性发作及失神发作癫痫的发作频率显著下降 ,发作频率减少≥ 5 0 %分别为88 89%、10 0 %、93 75 %、5 0 0 % ,副作用主要有胃纳差、体重减轻、无汗以及中枢神经系统的症状。结论 :托吡酯是一疗效高 ,安全性好的广谱的抗癫痫药 ,不但适用于难治性癫痫的加药治疗 ,且也适用于各种癫痫的单药治疗     

传统抗癫痫药物和托吡酯对成年癫痫患者生活质量的影响

背景:托吡酯现已广泛应用于临床治疗各型癫痫,但对国内成年癫痫患者生活质量影响的报道较少。目的:比较传统抗癫痫药物和托吡酯对成年癫痫患者生活质量的影响,以探讨产生影响的机制。设计:采用随机对照的临床研究。地点和对象:中南大学湘雅二医院及湘雅医院门诊新诊断癫痫患者,共102例,其中男60例,女42例,年龄16～60岁。干预:102例临床新确诊的成年癫痫患者被随机分为两组:一组予以传统抗癫痫药物单药系统治疗(传统抗癫痫药物组,54例),另一组予以托吡酯单药治疗(托吡酯组,48例)。1个月后比较两组的发作频率和不良反应,并用QOLIE-30量表对这102例癫痫患者进行生活质量评定。主要观察指标:①两组发作频率和不良反应。②生活质量评分。结果:托吡酯组的发作频率和不良反应均明显低于传统抗癫痫药物组,其中前者有效11例,显效7例,控制16例;而后者有效13例,显效5例,控制13例。托吡酯组的生活质量总分却明显高于传统抗癫痫药物组,分别为60±13和53±15,尤其在前5个分项的评分中更加明显。结论:托吡酯能提高癫痫患者的生活质量,其改善生活质量的作用主要是通过控制发作和减轻不良反应实现的。     

托吡酯添加治疗部分性癫痫发作对照研究

目的 观察托吡酯治疗部分性癫痫发作的临床疗效和安全性。方法 应用托吡酯对103例部分性癫痫发作患者进行开放性自身对照治疗试验。根据患者临床上对托吡酯的客观反应，调节其剂量和合并用药。结果 托吡酯对部分癫痫发作的总有效率为61．6％(其中简单部分性发作为54．8％，复杂部分性发作为67．1％，继发性全身性发作为60％)。发作完全控制为7．8％。各型癫痫发作形式的疗效之间无显著性差异，其不良反应大多发生在用药后一个月内，以体重下降最明显。结论 托吡酯是一种广谱有效安全的新型抗癫痫药物，对部分性发作均明显有效。不良反应轻，值得推广应用。     

托吡酯治疗小儿癫痫疗效及耐受性的临床分析

目的 :观察托吡酯治疗小儿癫痫的疗效和耐受性。方法 :确诊为小儿癫痫 5 9例 ,2 6例采用托吡酯加用、转换为单药治疗 ;2 2例单药治疗 ;11例由传统抗癫痫药 (AEDs)转换为托吡酯联合用药治疗。经 1～ 8周的加量期和 8周稳定期的观察 ,进行疗效、耐受性的评价。结果 :托吡酯治疗小儿癫痫总有效率 74 .5 8% (44 / 5 9)。单药治疗有效率 81.2 5 % (39/ 4 8) ;联合治疗有效率 4 5 .4 5 % (5 / 11)。托吡酯治疗小儿癫痫目标剂量 :2 .5～ 16mg·kg-1·d-1.平均 5 .6mg·kg-1·d-1。结论 :托吡酯抗癫痫有效 ,耐受性和预后良好     

低剂量托吡酯治疗卒中后癫痫临床观察

目的:观察低剂量托吡酯(TPM)治疗卒中后癫痫的有效性和安全性.方法:对32例卒中后癫痫患者予低剂量TPM治疗.以应用TPM前一个月的发作频率为基线,与应用TPM后稳定期3个月的平均月发作频率做比较,计算有效率,同时对TPM治疗前后的临床表现及实验室情况进行观察.对其中13例原已用抗癫痫药(AED)的患者,在维持原药剂量不变的情况下,加用TPM治疗.结果:本组病人TPM治疗后癫痫发作完全消失7例(21.88%),总有效率为71.88%.其中TPM单药治疗组有效率为78.95%.TPM添加治疗组有效率为61.54%.两组疗效经x2检验无显著性差异(P=0.2478,P＞0.05).结论:低剂量托吡酯治疗卒中后癫痫安全有效,可作为卒中后癫痫的首选药物之一.     

妥泰治疗病毒性脑炎继发癫痫的临床观察（附1例报告）

目的:探讨妥泰治疗病毒性脑炎继发癫痫的治疗效果。方法:病毒性脑炎继发癫痫的病人62例,随机分为治疗组32例,对照组30例,对照组按不同的发作类型分别服用苯妥英纳、丙戊酸纳、卡马西平及地西泮等药;治疗组则在此基础上加服妥泰。疗程为20周,治疗后进行疗效评定。结果:治疗后,治疗组临床疗效优于对照组,差异有非常显著意义(P<0.01)。结论:妥泰治疗病毒性脑炎继发癫痫安全有效。     

托吡酯治疗偏头痛的近期疗效

目的:观察托吡酯治疗偏头痛的近期疗效。方法:选取偏头痛病人72例,随机分为托吡酯组和对照组,每组36例。比较两组治疗后偏头痛疼痛强度、持续时间及治疗总有效率。结果:两组病人治疗后偏头痛均有改善,疼痛强度减轻,头痛持续时间缩短(P<0.01);与对照组比较,托吡酯组疼痛强度减轻明显,头痛持续时间更短(P<0.05),治疗后1个月止痛显效病例明显增加(χ2=8.02,P<0.01),总有效率显著提高(χ2=7.41,P<0.05)。结论:托吡酯治疗偏头痛,可以缩短病程,改善头痛症状,近期效果满意。     

Topiramate 100 mg/day in migraine prevention: a pooled analysis of double-blind randomised controlled trials

Topiramate has been shown to be effective as a preventive treatment for migraine in three large placebo-controlled, dose-ranging trials. Because the protocols were similar in design using the same primary and secondary endpoints, data from these studies were pooled to evaluate the consistency of efficacy, efficacy by gender and tolerability of topiramate 100 mg/day (n = 386) versus placebo (n = 372). Topiramate was superior to placebo as measured by the reduction in mean monthly migraine frequency, monthly migraine days and monthly migraine duration. The responder rates, defined as at least 50% reduction for the respective parameters, were significantly in favour of topiramate (p < 0.001), for example 46.3% of patients on topiramate achieved at least 50% reduction in monthly migraine period frequency compared with 22.8% on placebo (p < 0.001). Use of medication to treat the acute migraine attack was significantly reduced by topiramate compared with placebo (p < 0.001). The therapeutic effect was consistent throughout the different studies and independent of gender. The most common adverse effect was paraesthesia, mostly of mild-to-moderate severity. The findings confirm that, at a dose of 100 mg/day, topiramate is an effective and well-tolerated drug for migraine prevention.     

Practical Use of Topiramate for Migraine Prevention

When treating patients with migraine, clinicians should consider prescribing appropriate combinations of acute and preventive therapies. An effective migraine-preventive therapy should be prescribed to patients with frequent (≥2 migraines per month) or severe migraine. Topiramate has been shown to be an effective and generally well-tolerated migraine prophylaxis (preventive) therapy in adults, as demonstrated in several large, controlled trials. The most common adverse events in these trials were paresthesia, fatigue, anorexia, nausea, taste alteration, and diarrhea. Most adverse events were mild to moderate and transient in nature. Although patients should take migraine-preventive medications for approximately 2 to 3 months before evaluating effect, topiramate has shown efficacy as early as the first month of treatment. This article describes "real-world" approaches to using topiramate as a migraine-preventive therapy. Topiramate has received regulatory approval for the prophylaxis of migraine headache in adults in the United States and many other countries. The practical issues discussed in this article will enable clinicians to maximize the effectiveness while minimizing the side effects associated with this preventive agent.     

Practical use of topiramate for migraine prevention

When treating patients with migraine, clinicians should consider prescribing appropriate combinations of acute and preventive therapies. An effective migraine-preventive therapy should be prescribed to patients with frequent (> or = 2 migraines per month) or severe migraine. Topiramate has been shown to be an effective and generally well-tolerated migraine prophylaxis (preventive) therapy in adults, as demonstrated in several large, controlled trials. The most common adverse events in these trials were paresthesia, fatigue, anorexia, nausea, taste alteration, and diarrhea. Most adverse events were mild to moderate and transient in nature. Although patients should take migraine-preventive medications for approximately 2 to 3 months before evaluating effect, topiramate has shown efficacy as early as the first month of treatment. This article describes "real-world" approaches to using topiramate as a migraine-preventive therapy. Topiramate has received regulatory approval for the prophylaxis of migraine headache in adults in the United States and many other countries. The practical issues discussed in this article will enable clinicians to maximize the effectiveness while minimizing the side effects associated with this preventive agent.     

Topiramate for migraine prevention in children: a randomized, double-blind, placebo-controlled trial

OBJECTIVE: To assess the efficacy and safety of topiramate for the prevention of pediatric migraine with or without aura in a double-blind, randomized, placebo-controlled trial. BACKGROUND: Treatment options for pediatric migraine are currently limited, and no migraine preventive agents are approved for use in children in the United States. Topiramate is an effective migraine preventive therapy in adults, as demonstrated in several large, randomized, placebo-controlled trials. METHODS: One hundred and sixty-two children with migraine (age, 6 to 15 years) were randomized in a 2:1 ratio to receive topiramate (n = 112) or placebo (n = 50). This study was designed to ensure that 150 participants were randomized to study medication. An additional 12 qualified patients were randomized because they had successfully completed the screening phase. The double-blind phase of the trial consisted of a titration period and a maintenance period. Topiramate was initiated at 15 mg/day and titrated over 8 weeks to 2 to 3 mg/kg per day, or maximum tolerated dose, whichever was less (maximum allowed dose was 200 mg/day). The target dose was maintained for 12 weeks. The primary efficacy variable was the change in mean number of migraine days per month (28 days) during the double-blind phase relative to the 4-week prospective baseline phase for each treatment group. RESULTS: Topiramate treatment was associated with a mean reduction over the entire double-blind phase of 2.6 migraine days per month, compared with a mean reduction of 2.0 migraine days per month for placebo (P = .061 topiramate vs. placebo). A significantly greater percentage of topiramate patients (32%) experienced a > or = 75% reduction in mean monthly migraine days compared with placebo (14%, P = .02). Discontinuation rates due to adverse events were low: 6.5% for the topiramate group and 4.0% for the placebo group. The adverse events that occurred most commonly in the topiramate group at an incidence rate greater than in the placebo group were: upper respiratory tract infection, anorexia, weight decrease, gastroenteritis, paresthesia, and somnolence. The mean average daily dose of topiramate during the maintenance period was 2.0 mg/kg per day. CONCLUSIONS: This pilot study suggests that topiramate may be an effective migraine preventive therapy in children. Topiramate was well tolerated in this population. Further randomized studies would be required to definitively establish the efficacy of topiramate for pediatric migraine prevention.     

托吡酯治疗癫痫临床效果分析

目的观察托吡酯单药治疗各类癫痫的临床效果。方法回顾性分析2006年1月2009年1月收治的50例各类癫痫患儿采用托吡酯治疗后的临床资料。结果发作完全控制者22例,占56.8%;发作减少≥75%者8例,占20.0%;发作减少≥50%者10例,占22.7%,总有效率88.0%。无效10例,占12.0%。结论托吡酯单药治疗癫痫效果确切,完全控制率较高。     

Weight gain mitigation with topiramate in mood disorders

OBJECTIVE: To review the evidence of weight loss with use of topiramate in patients with mood disorders. DATA SOURCES: Literature search included MEDLINE (1966-December 2003), International Pharmaceutical Abstracts (1970-December 2003), and EMBASE (1980-December 2003). Search terms included topiramate, weight loss, adverse effect, mood disorders, bipolar disorder. DATA SYNTHESIS: Weight gain is a common adverse effect of many agents used to treat mood disorders. Topiramate has been evaluated in the management of some mood disorders, and weight loss may be a beneficial side effect in these patients. Case reports, letters to the editor, prospective investigations, and retrospective observational studies were reviewed to identify evidence of weight loss with topiramate use in patients with mood disorders. CONCLUSIONS: Current evidence suggests an association between topiramate and weight loss. Based on the limited data, controlled studies need to be conducted to define the role of topiramate in patients with mood disorders who would also benefit from weight reduction.