Striano Pasquale, Manganelli Fiore, Boccella Patrizia, Perretti Anna, Striano Salvatore
Epilepsy Center, Department of Neurological Sciences, University of Naples Federico II, Naples, Italy.
Mov Disord. 2005 Dec;20(12):1610-4. doi: 10.1002/mds.20530.
Levetiracetam is a new antiepileptic agent that exerts antimyoclonic effects. We conducted an open-label trial to evaluate the effect of levetiracetam in chronic cortical myoclonus of diverse etiologies and to determine whether levetiracetam affects electrophysiological findings. Sixteen patients, aged between 19 and 72 years, with refractory, chronic, cortical myoclonus were recruited. We assessed myoclonus severity with the Unified Myoclonus Rating Scale (UMRS). The electrophysiological study comprised jerk-locked averaging, somatosensory evoked potentials (SEPs), and long loop reflex I. Levetiracetam was administered add-on at a starting dose of 500 mg twice per day up to the target dose of 50 mg/kg/day. Patients were reevaluated clinically and electrophysiologically 2 weeks after the titration phase. Fourteen patients completed the trial. Posttreatment UMRS scores showed an improvement of myoclonus in all cases. Pretreatment, 9 patients had "giant" SEPs. Posttreatment, the amplitude of these SEPs was reduced by more than 50% in 3 of 9 patients, and the mean N20-P25 amplitude was reduced significantly. Pre- and posttreatment SEP amplitude was not related to myoclonus severity or duration. Levetiracetam is a promising and a relatively easy-to-test antimyoclonic agent, which has the potential to improve significantly the patient's disability; however, its long-term efficacy should be verified in larger controlled studies.
左乙拉西坦是一种具有抗肌阵挛作用的新型抗癫痫药物。我们进行了一项开放标签试验，以评估左乙拉西坦对各种病因的慢性皮质肌阵挛的疗效，并确定左乙拉西坦是否会影响电生理检查结果。招募了16名年龄在19至72岁之间、患有难治性慢性皮质肌阵挛的患者。我们使用统一肌阵挛评定量表（UMRS）评估肌阵挛严重程度。电生理研究包括抽搐锁定平均法、体感诱发电位（SEP）和长环反射I。左乙拉西坦以每日两次、起始剂量500mg的剂量加用给药，直至目标剂量50mg/kg/天。在滴定阶段后2周对患者进行临床和电生理重新评估。14名患者完成了试验。治疗后UMRS评分显示所有病例的肌阵挛均有改善。治疗前，9名患者有“巨大”SEP。治疗后，9名患者中有3名患者这些SEP的波幅降低了50%以上，且平均N20 - P25波幅显著降低。治疗前后SEP波幅与肌阵挛严重程度或病程无关。左乙拉西坦是一种有前景且相对易于测试的抗肌阵挛药物，有可能显著改善患者的残疾状况；然而，其长期疗效应在更大规模的对照研究中得到验证。
