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目的:了解拉莫三嗪(LTG)、丙戊酸钠(VPA)和维生素Be治疗儿童难治性癫痫的疗效。方法:收集儿童难治性癫痫32例,已在使用VPA且血药浓度在有效范围内(50～100ug/mL)者,即从0.15mg/(kg·d)、1次/天开始加LTG,第1个月每周增加LTG0.2mg/(kg·d),第2个月每周增加0.3mg/(kg·d),以后每周增加0.5～1mg/(kg·d),直至发作控制或剂量达10mg/kg·d)。未使用VPA者,从20mg/(kg·d)开始加VPA,并调整血药浓度至50～100ug/mL,再逐渐减停其它抗癫痫药物,加LTG,方法同上。所有患者口服维生素B630mg/天～60mg/天。结果:治疗12个月时17例(53.1%)完全控制,10例(31.25%)有效,5例(15.6%)无效,治疗后发作频率减少,差异有统计学意义(P<0.005),8例(25.0%)脑电图恢复正常,2例(6.25%)出现不良反应,所有患者均无明显血象及肝功改变。结论:LTG、VPA和维生素B,联用为1种有效、安全而且值得推广的治疗小儿难治性癫痫的方法。
Objective: To understand the efficacy of lamotrigine (LTG), valproate (VPA) and vitamin Be in the treatment of children with refractory epilepsy. Methods: Thirty-two cases of intractable epilepsy were collected in children with VPA in the effective range (50-100ug / mL), ie 0.15mg / (kg · d), once daily plus LTG , Increasing LTG0.2mg / (kg · d) every week in the first month, increasing 0.3mg / (kg · d) every week in the second month and increasing 0.5-1mg / (kg · d) every week until the onset Control or dose up to 10mg / kg · d). Without VPA, add VPA starting from 20mg / (kg · d), and adjust the plasma concentration to 50 ~ 100ug / mL, and then gradually stop the other antiepileptic drugs, add LTG, the method above. All patients oral vitamin B630mg / day ~ 60mg / day. Results: In the 12 months of treatment, 17 cases (53.1%) were completely controlled, 10 (31.25%) were effective and 5 (15.6%) were ineffective. The frequency of seizures decreased after treatment (P <0.005) EEG (25.0%) returned to normal, and adverse reactions occurred in 2 cases (6.25%). All patients had no significant changes in blood and liver function. Conclusion: Combination of LTG, VPA and vitamin B is an effective, safe and worthy method to treat refractory epilepsy in children.