局灶性癫痫患者经左乙拉西坦滴定治疗后颅内 γ-氨基丁酸（GABA）水平的变化。

Alterations of intracerebral γ-aminobutyric acid (GABA) levels by titration with levetiracetam in patients with focal epilepsies.

机构信息

Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany.

出版信息

Epilepsia. 2010 Aug;51(8):1477-82. doi: 10.1111/j.1528-1167.2010.02544.x.

DOI:10.1111/j.1528-1167.2010.02544.x

PMID:20345933

Abstract

PURPOSE

The objective of this study was to determine if levetiracetam (LEV) modulates brain γ-aminobutyric acid (GABA) in patients with epilepsy.

METHODS

Occipital GABA was assessed by protein magnetic resonance spectroscopy (¹H-MRS) in 16 patients with focal epilepsy at baseline and following the initiation of oral administration of LEV as monotherapy. Responder profiles were calculated as percentage of baseline seizure frequency. Alterations of GABA/Cr (creatine) of baseline measurements compared to GABA/Cr under LEV therapy were analyzed by Student's t-test for paired samples.

RESULTS

After administration of LEV, partial seizure reduction (> 50%) was noticed in 5 of 16 patients (31%; 7 of 16 (44%) patients turned out to be free of seizures. Patients with 50-100% seizure reduction under LEV titration were referred to as LEV responders. Of the 32 GABA spectra, only 22 (approximately 70%) yielded a result that met the criteria for spectral quality; therefore, GABA/Cr data from only seven patients were paired. A significant increase of GABA/Cr during titration with LEV was noted in patients responding to LEV (n = 5; p = 0.007). No differences in baseline GABA/Cr levels were detected between patients with and without previous antiepileptic treatment (p = 0.74).

DISCUSSION

The increasing GABA/Cr levels under drug titration only in LEV-responding epilepsy patients suggest a more complex and indirect influence of LEV on the GABAergic system.

摘要

目的

本研究旨在确定左乙拉西坦（LEV）是否能调节癫痫患者的大脑γ-氨基丁酸（GABA）。

方法

通过 ¹H-MRS 评估 16 例局灶性癫痫患者的枕叶 GABA，在基线和开始口服 LEV 单药治疗后进行评估。通过计算基线时的癫痫发作频率与 LEV 治疗下的基线测量的 GABA/Cr（肌酸）的百分比来计算应答者的特征。通过配对样本的学生 t 检验分析基线测量与 LEV 治疗下的 GABA/Cr 的变化。

结果

在 LEV 给药后，16 例患者中有 5 例（31%）出现部分癫痫发作减少（>50%），16 例患者中有 7 例（44%）无癫痫发作。在 LEV 滴定过程中癫痫发作减少 50-100%的患者被称为 LEV 应答者。在 32 个 GABA 谱中，只有 22 个（约 70%）满足了谱质量的标准，因此只有 7 名患者的 GABA/Cr 数据是配对的。在 LEV 滴定过程中，对 LEV 有反应的患者（n=5；p=0.007）的 GABA/Cr 显著增加。在有和没有既往抗癫痫治疗的患者之间，基线 GABA/Cr 水平没有差异（p=0.74）。