Objective To assess the effectiveness and safety of flunarizine for refractory epilepsy. Methods Relevant randomized controlled trials (RCTs) were searched from the database of PubMed, EMbase, Cochrane Library, CNKI, CBM, and VIP, and the related references were traced to obtain the information. The methodological quality of included RCTs was assessed using Jadad scale and meta-analysis was performed using RevMan 5.0 software. Results A total of eight studies involving 545 patients were included. The results of meta-analyses showed that: based on the conventional therapy, compared with placebo and none-treatment, flunarizine was more effective on adults and children with refractory epilepsy (OR=2.98, 95%CI 1.88 to -4.73; OR=33.75, 95%CI 4.13 to -276.00). Major adverse events of flunarizine were fatigue, dizziness, headache, and weight gain etc. All those symptoms except for the weight gain were observed in the early stage of medication, which might get self-cured or could disappear by constant medication or reducing the dose or symptomatic treatment. Conclusion The present study shows that based on the conventional therapy, flunarizine is effective and safe for refractory epilepsy.
目的 评估国际抗癫痫联盟（ILAE）耐药癫痫定义专家共识在发展中国家、发展中地区应用的可行性及应用中存在的问题。 方法 2010年12月9日－2011年2月18日，连续登记癫痫专科门诊患者409例。共纳入183例患者，根据ILAE耐药癫痫新定义对每位纳入患者癫痫分类进行评估。 结果 耐药癫痫患者18例（8.7%），临床治愈患者29例（14.1%），不能判断为159例（77.2%）。入组患者共涉及癫痫药物治疗方案321项。根据ILAE定义步骤一分类为不确定的治疗方案共有199项（62.00%），其中数量最多的为服药剂量＜50% WHO限定日剂量有157例（78.89%）。 结论 由于治疗剂量未能够达到国际统一标准，大量患者分类不明确，使得该共识应用面临巨大挑战，但目前为止该共识对于发展中地区耐药癫痫治疗有很强的指导促进意义，对未来耐药癫痫的早期识别有非常大的应用潜力。
目的 系统评价白细胞介素1β（IL-1β）与癫痫发作的相关性。 方法 2012年5月－2013年10月检索PubMed数据库（1985年1月－2013年7月）、Medline数据库（1985年1月－2013年7月）、中国知网（1998年1月－2013年7月）和万方数据库（1996年1月－2013年7月），并辅以谷歌学术搜索引擎进行手工检索。由两名研究者按照研究的纳入与排除标准进行病例对照研究的选择，对入选文献的质量参照“非随机对照临床试验质量评价标准与计分表”进行评价和计分，评估纳入研究的方法学质量并对有效的信息进行数据提取。然后采用RevMan 5.0统计软件进行Meta分析，以加权均数差（WMD）为效应指标。 结果 共纳入5个研究，包括82例癫痫发作的患者和471例正常对照。所纳入的研究未描述详细的抽样方法及其检测方法的特异性。Meta分析结果显示：癫痫发作72 h以内的患者与正常对照人群之间血浆IL-1β的浓度差异无统计学意义[WMD=0.04 pg/mL，95%CI（−0.07，0.16）pg/mL，P=0.46]。 结论 IL-1β可能没有直接参与癫痫的发作，而是通过与其他炎性因子之间的相互作用来实现。因此，需要进一步的研究来证明IL-1β在癫痫发作中的作用。
目的:β淀粉样蛋白（β-amyloid precursor protein，β-APP）是已知的参与阿尔茨海默病机制的关键因子。β-APP是否参与难治性癫痫中的病理机制并不清楚。这项研究在于了解β-APP的蛋白在难治性癫痫患者术后颞叶皮质和海马组织中的表达是否异常。方法:免疫荧光法半定量测定难治性癫痫患者术后颞叶皮质和海马组织中的β-APP阳性蛋白的荧光值，并应用统计软件对实验数据进行单因素方差分析。结果:免疫荧光强度值分析结果显示β-APP在耐药性癫痫脑组织中表达较对照组明显增高且有统计学意义。结论:β-APP在难治性癫痫脑组织中异常增高，增高的β-APP可能参与了难治性癫痫的病理机制。
目的:探讨癫痫发作致烧伤的临床特点及防治措施。方法:在系统抗癫痫的前提下，在抗休克、预防感染、营养支持等全身治疗同时，积极采用手术方法及早修复创面，结合良好的心理调试及护理。结果:该组43例患者除3例未完成治疗外，其余40例均痊愈出院，住院时间10~42天，住院期间出现癫痫再发作1例，经调整用药后控制，均无并发症发生。结论:采取系统的抗癫痫药物治疗与早期积极进行烧伤创面手术，全身和心理治疗并重的综合治疗方法，可使创面及早痊愈，明显降低癫痫再发作，是治疗癫痫合并烧伤的有效方法。
Objective To assess the efficacy and safety of gabapentin for restless legs syndrome (RLS). Methods Such databases as PubMed, EMbase, CENTRAL and CBM were searched for collecting the randomized controlled trials (RCTs) on the efficacy and/or tolerability of gabapentin for restless legs syndrome. Methodological quality of the trials was evaluated using the Cochrane risk-of-bias criteria, and meta-analysis was carried out using RevMan 5.1. Results Seven RCTs involving 1 163 patients which met the criteria were included, of which 4 were placebo parallel controlled trials and 3 were placebo cross-over trials. The outcomes of meta-analysis suggested that a) As to the change of RLS severity based on IRLSSG score, gabapentin was superior to placebo in alleviating the severity of RLS (MD= –3.24, 95%CI –4.40 to –2.09, Plt;0.000 01); b) As to the response rate based on investigator-rated CGI-I scale, it was higher in the gabapentin group (77%) compared with that in the placebo group (50%) (RR=1.81, 95%CI 1.54 to 2.11, Plt;0.000 01); c) As to quality of sleep, gabapentin was superior to placebo in reducing sleep disturbance (MD= –11.31, 95%CI –14.46 to –8.16), assuring quality of sleep (MD= 0.27, 95%CI 0.10 to 0.44) and alleviating daytime somnolence (MD= –3.96, 95%CI –6.42 to –1.50); and d) As to the RLS pain score, gabapentin was better in relieving pain compared with placebo (MD= –0.97, 95%CI –1.47 to –0.47). In addition, main side effects were somnolence (3.1% to 26.5%) and dizziness (2.1% to 19.5%), and there was a significant difference between two groups. Conclusion Gabapentin can effectively alleviate RLS patients’ condition, improve quality of sleep, relieve pain and show good tolerability.
Objective To assess the effectiveness and safety of progabide (PGB) for refractory epilepsy. Methods Randomized controlled trials (RCTs) on PGB treating refractory epilepsy were searched from the following databases as PubMed, EMbase, The Cochrane Library, CNKI, CBM and VIP from the date of their establishment to July 2011. The data of RCTs meeting the inclusive criteria were extracted according to Cochrane methods by two reviewers independently, and after the quality was evaluated and cross-checked, meta-analyses were conducted using RevMan 5.1 software. Results A total of seven studies involving 231 patients were included. The results of Meta-analyses showed that based on the conventional therapy, PGB was ineffective in treating refractory partial epilepsy compared with the placebo (OR=1.76, 95%CI 0.40 to 7.65, P=0.45), but it was superior to the placebo in treating refractory partial and generalized epilepsy (OR=4.46, 95%CI 2.06 to 9.65, P=0.000 1). The main adverse events of PGB were somnolence, dizziness and headache, which were mild and transient, which could turn to normal after reducing the dose of PGB and only a few patients needed to stop taking PGB. Conclusion Current studies shows that progabide may be effective in treating refractory partial and generalized epilepsy, but its effectiveness in treating refractory partial epilepsy is still unknown. The side effects of PGB are mostly mild. For the possibility of moderate selection bias existing in the quality of the included studies which may affect the authenticity of outcomes, so this conclusion still needs to be further proved by conducting more high-quality, large-scale and double-blinded RCTs.
We searched The Cochrane Library（Issue 3, 2005）, MEDLINE（1996-2005） ,CMCC（1996-2005）, VIP（1996-2005） ,CNKI（1996-2005） to summarize the available evidence of topiramate for an intractable epilepsy. After scanning all these articles, we identified 11 articles including meta-analysis, randomised controlled trials and systematic reviews to evaluate. Topiramate offered an alternative in the treament for intractable epilepsy, especially for partial epilepsy, and its efficacy was proven. Patients had good tolerance. And no intercross effects with the traditional anti-epileptic drugs were found. So topiramate had broad clinical value. The primary dosage of topiramate was 200mg/d. The sustaining dosage was 400-600mg/d. And we didn＇t recommend the dosage of more than 600mg/d.
目的 利用磁共振弥散张量成像技术（DTI）对右侧难治性颞叶癫痫（TLE）患者术前及术后脑白质各向异性分数（FA）进行纵向随访研究，并对其与病程等临床症状之间的相关性进行分析，探讨右侧TLE患者的脑白质FA变化模式。 方法 2008年7月－2009年8月纳入10例右侧难治性TLE患者。对每个受试者采用GE 3.0 T磁共振及8通道头线圈扫描，所有DTI图像通过单次回波平面成像序列采集。采用基于体素分析的SPM8软件对受试患者术前术后FA图进行配对t检验，观察难治性TLE患者脑白质变化模式。采用Pearson相关计算FA变化幅度与病程等临床症状之间的相关性，经比较校正后P值＜0.05的区域为有统计学意义的区域。 结果 右侧TLE患者FA值降低的区域包括左侧颞下回、双侧额中回及左侧壳核、右侧楔叶。FA升高的区域包括左侧海马旁回、左侧颞叶、右侧额下回和左侧中央旁小叶。相关分析发现，右侧TLE患者右侧额下回FA变化值与发病年龄呈负相关，左侧颞下回FA变化值与术后随访间隔时间呈负相关。 结论 右侧难治性TLE患者手术治疗后大脑白质变化不仅局限于颞叶，还涉及颞叶外结构。
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。