Leiderman D B, Balish M, Bromfield E B, Theodore W H
Clinical Epilepsy Section, NINDS, National Institutes of Health, Bethesda, Maryland 20892.
Epilepsia. 1991 May-Jun;32(3):417-22. doi: 10.1111/j.1528-1157.1991.tb04671.x.
We studied the effects of valproate (VPA) on local cerebral glucose metabolism (LCMRglc) in eight patients with partial seizure disorders and two with primary generalized epilepsy. Each patient had two positron-emission tomography (PET) scans with 18F-2-deoxyglucose (FDG), with, and without, VPA (mean level 52 mg/dl, range 30-127 mg/dl). Patients continued carbamazepine (CBZ) for both scans: serum concentrations were not significantly changed by VPA (CBZ range 5.4-12 mg/dl). Seven patients had the "without-VPA" scan first. Mean interval between PET scans was 75 days. Global CMRglc was decreased by 22% by addition of VPA (7.2 +/- 1.8 mg/100 g/min without VPA, 5.6 +/- 1.1 g/min with VPA, p less than 0.05, corrected). Thirteen regions of interest (ROIs) were analyzed in each hemisphere in each PET scan. Metabolic rates were significantly lower in 15 of 26 ROIs with VPA (p less than 0.05, corrected). VPA depresses cerebral metabolism to a greater degree than do CBZ and phenytoin (PHT) but less than does phenobarbital (PB). The metabolic effect may be related to the mechanism of action and have neuropsychological implications.
我们研究了丙戊酸盐（VPA）对8例部分性癫痫患者和2例原发性全身性癫痫患者局部脑葡萄糖代谢（LCMRglc）的影响。每位患者均进行了两次正电子发射断层扫描（PET），分别在服用VPA（平均水平52mg/dl，范围30 - 127mg/dl）和未服用VPA的情况下注射18F - 脱氧葡萄糖（FDG）。两次扫描期间患者均继续服用卡马西平（CBZ）：VPA对其血清浓度无显著影响（CBZ范围5.4 - 12mg/dl）。7例患者先进行了“未服用VPA”的扫描。PET扫描之间的平均间隔为75天。添加VPA后，全脑葡萄糖代谢率（CMRglc）降低了22%（未服用VPA时为7.2±1.8mg/100g/min，服用VPA时为5.6±1.1g/min，校正后p<0.05）。每次PET扫描时，在每个半球分析13个感兴趣区域（ROI）。服用VPA时，26个ROI中有15个的代谢率显著降低（校正后p<0.05）。与卡马西平（CBZ）和苯妥英（PHT）相比，VPA对脑代谢的抑制作用更大，但小于苯巴比妥（PB）。这种代谢效应可能与作用机制有关，并具有神经心理学意义。
