Jamora Dominic, Lim Shih-Hui, Pan Andrew, Tan Louis, Tan Eng-King
Department of Neurology, National Neuroscience Institute, Singapore.
Mov Disord. 2007 Jan;22(1):130-3. doi: 10.1002/mds.21188.
We systematically examined 226 epilepsy patients in a tertiary-referral center and found 6 (5.04%) to have valproate-induced Parkinsonism. There was a significantly higher prevalence of patients with Parkinsonism in the group of patients treated with valproate compared to those who were on other antiepileptic drugs (6 [5.04%] of 119 vs. 0 [0%] of 107; chi2 = 5.54; P = 0.025). These six patients had been on valproate for more than 3 years (mean, 75.67 +/- 25.32 months) at an average dose of 750 +/- 273.86 mg/day. The valproate doses were decreased or discontinued with supplementation from another antiepileptic medication. The mean UPDRS motor score significantly improved from 10.67 +/- 5.1 to 4.75 +/- 2.75 (P < 0.05). There was no relapse of seizures. Clinicians working in tertiary-referral centers should have a high index of suspicion for valproate-induced Parkinsonism. Early recognition and switching into another antiepileptic medication may help reduce unnecessary suffering in these patients.
我们在一家三级转诊中心对226例癫痫患者进行了系统检查，发现6例（5.04%）患有丙戊酸盐诱发的帕金森症。与使用其他抗癫痫药物的患者相比，使用丙戊酸盐治疗的患者中帕金森症的患病率显著更高（119例中有6例[5.04%]，而107例中为0例[0%]；卡方检验=5.54；P=0.025）。这6例患者服用丙戊酸盐已超过3年（平均75.67±25.32个月），平均剂量为750±273.86毫克/天。减少或停用丙戊酸盐，并加用另一种抗癫痫药物。统一帕金森病评定量表（UPDRS）运动评分从10.67±5.1显著改善至4.75±2.75（P<0.05）。癫痫未复发。在三级转诊中心工作的临床医生应对丙戊酸盐诱发的帕金森症保持高度怀疑。早期识别并换用另一种抗癫痫药物可能有助于减轻这些患者的不必要痛苦。
