Department of Pediatric Neurology, Assaf Harofeh Medical Center, Zerifin, Israel.
Pediatr Neurol. 2012 Dec;47(6):427-30. doi: 10.1016/j.pediatrneurol.2012.08.002.
The correlation between lamotrigine serum concentration, efficacy, and toxicity in children is controversial. The database of the Clinical Pharmacology Laboratory at Assaf Harofeh Medical Center was retrospectively searched to identify lamotrigine serum concentrations in children aged 2-19 years with refractory epilepsy who received lamotrigine as monotherapy or polytherapy from 2007-2010. Data collected included age at epilepsy onset, additional antiepileptic drugs, lamotrigine dose, monthly seizure frequency before and after lamotrigine treatment, and side effects. Sixty blood samples were collected from 42 children aged 10.1 ± 4.9 years (range, 2-20 years). Seizure types included complex partial (n = 28), simple partial (n = 7), absence (n = 2), and generalized tonic-clonic (n = 23). Decreased seizure frequency was observed in 38 (63.3%) patients. No correlation with lamotrigine serum concentration was evident, but seizure frequency was significantly influenced by age and lamotrigine dose. Side effects were reported in 21 (35%) patients. Only diplopia was significantly correlated with lamotrigine serum concentration. Lamotrigine was more effective at lower doses and in older children. Lamotrigine serum concentration correlated significantly with diplopia, but not with other side effects or with clinical efficacy. Overall, lamotrigine is effective and safe in children with refractory epilepsy.
拉莫三嗪血清浓度、疗效和毒性与儿童的相关性存在争议。回顾性检索阿萨夫·哈罗菲医学中心临床药理学实验室的数据库，以确定 2007 年至 2010 年间接受拉莫三嗪单药或联合治疗的难治性癫痫儿童（年龄 2-19 岁）的拉莫三嗪血清浓度。收集的数据包括癫痫发作年龄、其他抗癫痫药物、拉莫三嗪剂量、拉莫三嗪治疗前后每月癫痫发作频率以及副作用。从 42 名年龄为 10.1±4.9 岁（年龄范围 2-20 岁）的儿童中采集了 60 份血样。癫痫发作类型包括复杂部分性（n=28）、简单部分性（n=7）、失神性（n=2）和全面性强直阵挛性（n=23）。38 名（63.3%）患者的癫痫发作频率降低。虽然未发现拉莫三嗪血清浓度与疗效有相关性，但癫痫发作频率显著受年龄和拉莫三嗪剂量影响。21 名（35%）患者出现副作用。仅复视与拉莫三嗪血清浓度显著相关。拉莫三嗪在低剂量和年龄较大的儿童中效果更好。拉莫三嗪血清浓度与复视显著相关，但与其他副作用或临床疗效无显著相关性。总体而言，拉莫三嗪治疗儿童难治性癫痫有效且安全。
