Zhu Fei, Lang Sen-Yang, Wang Xiang-Qing, Shi Xiao-Bing, Ma Yun-Feng, Zhang Xu, Chen Ya-Nan, Zhang Jia-Tang
Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Chin Med J (Engl). 2015 Nov 20;128(22):3015-22. doi: 10.4103/0366-6999.168968.
It is important to choose an appropriate antiepileptic drug (AED) to manage partial epilepsy. Traditional AEDs, such as carbamazepine (CBZ) and valproate (VPA), have been proven to have good therapeutic effects. However, in recent years, a variety of new AEDs have increasingly been used as first-line treatments for partial epilepsy. As the studies regarding the effectiveness of new drugs and comparisons between new AEDs and traditional AEDs are few, it is determined that these are areas in need of further research. Accordingly, this study investigated the long-term effectiveness of six AEDs used as monotherapy in patients with partial epilepsy.
This is a retrospective, long-term observational study. Patients with partial epilepsy who received monotherapy with one of six AEDs, namely, CBZ, VPA, topiramate (TPM), oxcarbazepine (OXC), lamotrigine (LTG), or levetiracetam (LEV), were identified and followed up from May 2007 to October 2014, and time to first seizure after treatment, 12-month remission rate, retention rate, reasons for treatment discontinuation, and adverse effects were evaluated.
A total of 789 patients were enrolled. The median time of follow-up was 56.95 months. CBZ exhibited the best time to first seizure, with a median time to first seizure of 36.06 months (95% confidential interval: 30.64-44.07). CBZ exhibited the highest 12-month remission rate (85.55%), which was significantly higher than those of TPM (69.38%, P = 0.006), LTG (70.79%, P = 0.001), LEV (72.54%, P = 0.005), and VPA (73.33%, P = 0.002). CBZ, OXC, and LEV had the best retention rate, followed by LTG, TPM, and VPA. Overall, adverse effects occurred in 45.87% of patients, and the most common adverse effects were memory problems (8.09%), rashes (7.76%), abnormal hepatic function (6.24%), and drowsiness (6.24%).
This study demonstrated that CBZ, OXC, and LEV are relatively effective in managing focal epilepsy as measured by time to first seizure, 12-month remission rate, and retention rate.
选择合适的抗癫痫药物（AED）来治疗部分性癫痫很重要。传统的AED，如卡马西平（CBZ）和丙戊酸盐（VPA），已被证明具有良好的治疗效果。然而，近年来，多种新型AED越来越多地被用作部分性癫痫的一线治疗药物。由于关于新药有效性以及新型AED与传统AED之间比较的研究较少，确定这些是需要进一步研究的领域。因此，本研究调查了六种AED单药治疗部分性癫痫患者的长期有效性。
这是一项回顾性长期观察研究。确定了2007年５月至2014年10月期间接受六种AED之一单药治疗的部分性癫痫患者，这六种AED分别为CBZ、VPA、托吡酯（TPM）、奥卡西平（OXC）、拉莫三嗪（LTG）或左乙拉西坦（LEV），并对其进行随访，评估治疗后首次发作时间、12个月缓解率、保留率、治疗中断原因及不良反应。
共纳入789例患者。中位随访时间为56.95个月。CBZ的首次发作时间最佳，首次发作的中位时间为36.06个月（95%置信区间：30.64 - 44.07）。CBZ的12个月缓解率最高（85.55%），显著高于TPM（69.38%，P = 0.006）、LTG（70.79%，P = 0.001）、LEV（72.54%，P = 0.005）和VPA（73.33%，P = 0.002）。CBZ、OXC和LEV的保留率最佳，其次是LTG、TPM和VPA。总体而言，45.87%的患者出现了不良反应，最常见的不良反应是记忆问题（8.09%）、皮疹（7.76%）、肝功能异常（6.24%）和嗜睡（6.24%）。
本研究表明，以首次发作时间、12个月缓解率和保留率衡量，CBZ、OXC和LEV在治疗局灶性癫痫方面相对有效。
