Hwang Hee, Kim Hunmin, Kim Seung Hyo, Kim Se Hee, Lim Byung Chan, Chae Jong-Hee, Choi Ji Eun, Kim Ki Joong, Hwang Yong Seung
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.
Brain Dev. 2012 May;34(5):344-8. doi: 10.1016/j.braindev.2011.08.007. Epub 2011 Sep 3.
We performed this study to evaluate the long-term efficacy and tolerability of ethosuximide (ESX), valproic acid (VPA), and lamotrigine (LTG) as initial monotherapies for patients with newly diagnosed childhood absence epilepsy.
We retrospectively reviewed the medical records of 128 patients (45 boys and 83 girls) diagnosed with childhood absence epilepsy at the Seoul National University Hospital. The diagnosis was based on the criteria proposed by Panayiotopoulos in 2005. We measured the seizure-free rate and the retention rate observed during 2 years of treatment. Follow-up electroencephalography (EEG), any reported adverse events, and reasons for antiepileptic drug (AED) discontinuation were reviewed.
The seizure-free rate of ESX (84%) was significantly higher than that of VPA (62%) and LTG (53%) at 3 months. The seizure-free rate of ESX (90%) was significantly higher than that of LTG (63%) at 6 months. After 9 months, there was no significant difference in seizure-free rate among the three groups. There were no significant differences among the three groups in terms of normalization of EEG at 12 months (ESX, 77%; VPA, 83%; and LTG, 64%), retention rate throughout the whole treatment period, and adverse-event rates (ESX, 25%; VPA, 29%; and LTG, 14%).
This study suggests that ESX, VPA, and LTG are equally effective in the long-term treatment of newly diagnosed CAE patients. However, the onset of efficacy was faster for ESX compared with VPA or LTG. Efficacy, tolerability, and adverse event profiles should be carefully considered when selecting AEDs to treat individual patients with CAE.
我们开展本研究以评估乙琥胺（ESX）、丙戊酸（VPA）和拉莫三嗪（LTG）作为新诊断儿童失神癫痫患者初始单药治疗的长期疗效和耐受性。
我们回顾性分析了首尔国立大学医院128例（45例男孩和83例女孩）诊断为儿童失神癫痫患者的病历。诊断依据2005年帕纳约托普洛斯提出的标准。我们测量了治疗2年期间的无癫痫发作率和留存率。回顾了随访脑电图（EEG）、任何报告的不良事件以及停用抗癫痫药物（AED）的原因。
3个月时，ESX的无癫痫发作率（84%）显著高于VPA（62%）和LTG（53%）。6个月时，ESX的无癫痫发作率（90%）显著高于LTG（63%）。9个月后，三组间无癫痫发作率无显著差异。三组在12个月时脑电图正常化方面（ESX，77%；VPA，83%；LTG，64%）、整个治疗期间的留存率以及不良事件发生率（ESX，25%；VPA，29%；LTG，14%）方面均无显著差异。
本研究表明，ESX、VPA和LTG在新诊断CAE患者的长期治疗中同样有效。然而，与VPA或LTG相比ESX起效更快。在为个体CAE患者选择AEDs时，应仔细考虑疗效、耐受性和不良事件情况。
