Department of Developmental Neurology, Chair of Neurology, Medical University of Gdańsk, Poland.
Seizure. 2010 Apr;19(3):195-7. doi: 10.1016/j.seizure.2010.01.014. Epub 2010 Feb 18.
In order to estimate and compare the long-term effectiveness of lamotrigine (LTG) versus valproate (VPA) monotherapy in treatment of newly diagnosed idiopathic generalized epilepsies (IGE) the following study was performed.
Medical records of 214 children and adolescents suffering from IGE were analyzed. 132 of them were on VPA monotherapy, 82 on LTG. The majority of patients had juvenile myoclonic epilepsy - 98, the rest: juvenile absence epilepsy - 32, childhood absence epilepsy - 53 and epilepsy with a tonic-clonic seizures on awakening - 12, others - 19. Mean age of the patients was 8.9 years (range 4-16 years). The mean time of treatment was 28 months, time of observation 40 months. In order to estimate retention rates and factors predicting successful treatment with LTG and VPA we used Kapplan-Meyer analysis and Gehan tests.
Data analysis showed significantly longer retention rates with VPA versus LTG treatment in overall rates as well in all syndromes subgroups. After 12 months of therapy 69% stayed on LTG therapy versus 89% on VPA, after 24 months 57% versus 83% respectively. VPA showed comparable efficacy in all IGE syndromes where LTG showed better efficacy in childhood and juvenile absence epilepsy than in juvenile myoclonic epilepsy. The shorter duration of treatment with LTG was due to lack of efficacy.
Our results show the superiority of VPA versus LTG treatment in idiopathic generalized epilepsy syndromes.
为了评估和比较拉莫三嗪（LTG）与丙戊酸（VPA）单药治疗新诊断的特发性全面性癫痫（IGE）的长期疗效，进行了这项研究。
分析了 214 例患有 IGE 的儿童和青少年的病历。其中 132 例接受 VPA 单药治疗，82 例接受 LTG 单药治疗。大多数患者患有青少年肌阵挛癫痫-98 例，其余为：青少年失神癫痫-32 例，儿童失神癫痫-53 例，觉醒性强直阵挛发作癫痫-12 例，其他类型-19 例。患者的平均年龄为 8.9 岁（范围 4-16 岁）。平均治疗时间为 28 个月，观察时间为 40 个月。为了评估保留率和预测 LTG 和 VPA 成功治疗的因素，我们使用了 Kaplan-Meier 分析和 Gehan 检验。
数据分析表明，VPA 的保留率明显高于 LTG，无论是总体保留率还是所有综合征亚组的保留率。治疗 12 个月后，69%的患者继续接受 LTG 治疗，89%的患者继续接受 VPA 治疗；治疗 24 个月后，57%的患者继续接受 LTG 治疗，83%的患者继续接受 VPA 治疗。VPA 在所有 IGE 综合征中均显示出相当的疗效，而 LTG 在儿童和青少年失神癫痫中比在青少年肌阵挛癫痫中疗效更好。LTG 治疗时间较短是因为疗效不佳。
我们的研究结果表明，VPA 在特发性全面性癫痫综合征中优于 LTG 治疗。
