Epilepsy Unit, Gui de Chauliac Hospital, Montpellier, France.
Seizure. 2011 Jul;20(6):500-1. doi: 10.1016/j.seizure.2011.02.005. Epub 2011 Mar 3.
Lennox-Gastaut syndrome (LGS) is a well-defined epileptic encephalopathy highly drug resistant. The first-line treatment option is valproate (VPA), usually in combination with lamotrigine. VPA has been linked to serious hepatotoxicity. We report a 22-year-old liver transplanted patient with LGS successfully treated with VPA in combination with phenobarbital (100 mg/d; blood level: 36 mg/l), lamotrigine (125 mg/d; blood level: 4.81 mg/l) and topiramtate (175 mg/d), as well as immunosuppressive, antiviral, anti-anemic, hypo-phosphoric and alkaline medication. On VPA 1000 mg/d, the seizure frequency decreased significantly. Taking into consideration the patient's good tolerance and the normal liver function, VPA was increased to 1500 mg/d. At this dose the daily drop attacks and generalized tonic-clonic seizures totally ceased. The patient presented only some tonic seizures around awakening. During many years, VPA was avoided in this patient because of its potential hepatotoxicity. However the good functioning of the transplanted liver permitted its introduction. VPA can be used safely in liver transplanted patients under the strict control of the hepatic function.
Lennox-Gastaut 综合征（LGS）是一种明确的抗药性癫痫性脑病。一线治疗选择是丙戊酸钠（VPA），通常与拉莫三嗪联合使用。VPA 与严重的肝毒性有关。我们报告了一例 22 岁的肝移植患者，成功地使用 VPA 联合苯巴比妥（100mg/d；血药浓度：36mg/l）、拉莫三嗪（125mg/d；血药浓度：4.81mg/l）和托吡酯（175mg/d）治疗 LGS，同时还进行了免疫抑制、抗病毒、抗贫血、低磷和碱性治疗。在 VPA 1000mg/d 的剂量下，癫痫发作频率显著降低。考虑到患者的良好耐受性和正常的肝功能，将 VPA 增加到 1500mg/d。在此剂量下，每日强直阵挛性发作和全面性强直阵挛性发作完全停止。患者仅在觉醒时出现一些强直发作。由于 VPA 潜在的肝毒性，多年来一直避免在该患者中使用。然而，移植肝脏的良好功能使其得以引入。VPA 可以在严格控制肝功能的情况下安全地用于肝移植患者。
