目的 比较5种新一代抗癫痫药物对成人全面强直阵挛发作单药治疗的保留率。 方法 选择2010年7月－2011年6月354例确诊为癫痫全面强直阵挛发作患者，分别采用拉莫三嗪、左乙拉西坦、奥卡西平、托吡酯、加巴喷丁5种药物进行单药治疗，对其5种药物的6、12个月保留率进行比较。 结果 5种药物的6、12个月保留率分别为：拉莫三嗪90.8%、79.8%，左乙拉西坦88.0%、66.7%，奥卡西平82.1%、58.2%，托吡酯81.2%、58.0%，加巴喷丁26.5%、20.6%。6个月保留率加巴喷丁与其他4种药物比较差异有统计学意义（P＜0.001），其他药物之间差异无统计学意义。12个月保留率拉莫三嗪与其他4种药物比较差异有统计学意义（P＜0.005），其他药物之间差异无统计学意义。 结论 拉莫三嗪对成人全面强直阵挛发作单药治疗12个月保留率最高。通过对5种新一代抗癫痫药物12个月保留率比较研究，可以对临床单药治疗癫痫药物选择提供一定参考。
ObjectiveTo develop a score system to predict the probability of failure of monotherapy in epilepsy patients with initial treatment, and then provide pillars for early use of polytherapy.MethodsThis is a retrospective analysis of the clinical data of 189 patients with epilepsy treated in Department of Neurology, the Third Xiangya Hospital of Central South University from January 2019 to July 2020. Patients were divided into monotherapy acceptable group and monotherapy poor effect group according to their drug treatment plan and drug efficacy. The influencing factors were screened out by single factor analysis and binary logistic regression analysis. And on the basis of this β value, a quantitative scoring table for predicting the unsatisfying treatment effect of monotherapy is developed. And the receiver operating curve (ROC curve) was used to evaluate the effectiveness of the scale.ResultsBased on a standard of 75% reduction in seizures during the observation period, 138 cases (73%) were effective with monotherapy plan, while 51 cases (23%) were unsatisfactory. Regression analysis showed that multiple forms of seizures, status epilepticus (t2), brain damage, and the number of seizures ≥ 7 times before treatment are independent risk factors for poor outcome of monotherapy. The resulting score sheet has a total score of 12 points; the area under the ROC curve is 0.779, and the critical score is 6 points (sensitivity: 0.314; specificity: 0.957). Patients with more than this score have a strong probability of poor response in monotherapy.ConclusionThis prediction model can effectively assess the risk of unsatisfactory therapeutic effect of monotherapy in epilepsy patients who are initially treated, and thus has reference function for the early selection of polytherapy.
ObjectiveTo compare the efficacy and safety of perampanel (PER) and oxcarbazepine (OXC) monotherapy in the treatment of newly diagnosed focal epilepsy in adults. Methods A total of 62 adult patients with focal epilepsy, aged 18~79 years old, with an average age of (40.53±16.69) years, were enrolled from Qingyuan People’s Hospital between August 2021 and October 2022 and randomly divided into PER group and OXC groups. Both groups were followed up for 12 months and assessed for seizure free rate, effective rate, drug retention rate, and adverse reactions at 3, 6, and 12th months. ResultsThe results showed that the seizure free rate, effective rate, and drug retention rate in the PER group were 62.5%, 71.9% and 87.5% at 3 months, respectively, and 53.1%, 65.6% and 75.0% at 6 months respectively. In the OXC group, the seizure free rate, effective rate, and drug retention rate were 70.0%, 86.7%, and 93.3% at 3 months, respectively, and 66.7%, 73.3% and 83.3% at 6 months, respectively. At 12 months, the seizure free rate, effective rate and retention rate of the PER group were 43.8%, 46.9%, and 53.1%, respectively; The seizure free rate, effective rate, and retention rate of OXC group were 66.7%, 66.7%, and 70.0%, respectively. The incidence of adverse reactions in the PER group and OXC group was 15.6% and 16.7%, respectively. The most common adverse reactions in both groups were dizziness and drowsiness, with no serious adverse events. ConclusionPER and OXC monotherapy demonstrated similar efficacy and safety in the treatment of newly diagnosed adult focal epilepsy, and both drugs can be used as safe and effective treatment options.