抗癫痫药物的使用对儿童生长的影响。
The impact of the use of antiepileptic drugs on the growth of children.
机构信息
Department of Paediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
出版信息
BMC Pediatr. 2013 Dec 19;13:211. doi: 10.1186/1471-2431-13-211.
BACKGROUND
This study investigated whether long-term treatment with antiepileptic drugs (AEDs) had negative effects on statural growth and serum calcium levels in children with epilepsy in Taiwan.
METHODS
Children with epilepsy treated with one prescription of AEDs (monotherapy) for at least 1 year were selected. The AEDs included valproic acid (VPA; Deparkin) in 27 children (11 boys and 16 girls) aged 4-18 years, oxcarbazepine (Trileptal) in 30 children (15 boys and 15 girls) aged 5-18 years, topiramate (Topamax) in 19 children (10 boys and 9 girls) aged 6-18 years, and lamotrigine (Lamicta) in eight children (5 boys and 3 girls) aged 5-13 years. Patients with a history of febrile convulsions were selected as the controls.
RESULTS
One year of VPA treatment significantly impaired the statural growth of pediatric patients with epilepsy (p < 0.005) compared with the control group. The underlying mechanism may have been due to the direct effect of VPA on the proliferation of growth plate chondrocytes rather than alterations of serum calcium.
CONCLUSIONS
These results raise serious concerns about the growth of pediatric epilepsy patients who use AEDs, and potentially the need to closely monitor growth in children with epilepsy and adolescents under AED treatment, especially VPA.
背景
本研究旨在探讨台湾地区癫痫儿童长期使用抗癫痫药物（AEDs）治疗是否会对其身高生长和血清钙水平产生负面影响。
方法
选择至少使用一种 AED（单药治疗）治疗 1 年以上的癫痫儿童。AED 包括丙戊酸（VPA；Deparkin）27 例（男 11 例，女 16 例），年龄 4-18 岁；奥卡西平（Trileptal）30 例（男 15 例，女 15 例），年龄 5-18 岁；托吡酯（Topamax）19 例（男 10 例，女 9 例），年龄 6-18 岁；拉莫三嗪（Lamicta）8 例（男 5 例，女 3 例），年龄 5-13 岁。选择有热性惊厥史的患者作为对照组。
结果
VPA 治疗 1 年显著损害了癫痫儿科患者的身高生长（p < 0.005），与对照组相比。其潜在机制可能是由于 VPA 直接作用于生长板软骨细胞的增殖，而不是血清钙的改变。
结论
这些结果引起了对使用 AEDs 的癫痫儿科患者生长的严重关注，可能需要密切监测接受 AED 治疗的癫痫儿童和青少年的生长情况，特别是 VPA。
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