Department of Neurology, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu Province, China.
Eur Rev Med Pharmacol Sci. 2017 Jul;21(14):3327-3331.
To study the clinical value of anti-epileptic drugs combined with B vitamins in the treatment of epilepsy after stroke.
The study included 90 consecutive patients with epilepsy after stroke. Patients were randomly divided into groups of 30 each according to treatment: single-agent or combination anti-epileptic therapy with oxcarbazepine and sodium valproate (control group), anti-epileptic therapy with compound vitamin B tablets (observation group 1), and anti-epileptic therapy with vitamin B12 (mecobalamin) (observation group 2). After 12 months, treatment effects were assessed and compared among groups.
Compared with the control group, observation group 2 had better epilepsy control and observation group 1 had no difference in efficacy. New-onset stroke was seen in three cases (10%) of the control group and in two cases (6.7%) of observation group 1. This was not seen in observation group 2. In the control group and observation group 1, National Institutes of Health Stroke Scale (NIHSS) score significantly decreased after 6 months, but increased again at 12 months. Conversely, NIHSS score continuously decreased during follow-up in observation group 2. The plasma level of asymmetric dimethyl arginine (ADMA) gradually increased in the control group and observation group 1, but remained unchanged in observational group 2. The differences in NIHSS scores and plasma ADMA levels between the control and observation groups were statistically significant.
Anti-epilepsy drugs combined with B vitamins can improve epilepsy control after stroke and reduce new stroke occurrence. This effect may be associated with stability of plasma ADMA levels. Vitamin B12 may be better than vitamin B complex in the treatment of epilepsy after stroke.
研究抗癫痫药物联合 B 族维生素治疗脑卒中后癫痫的临床价值。
本研究纳入 90 例连续脑卒中后癫痫患者。根据治疗方法将患者分为 3 组，每组 30 例：奥卡西平+丙戊酸钠单药或联合抗癫痫治疗（对照组）、复合维生素 B 片抗癫痫治疗（观察组 1）、甲钴胺（观察组 2）抗癫痫治疗。治疗 12 个月后评估各组疗效。
与对照组相比，观察组 2 的癫痫控制效果更好，观察组 1 的疗效无差异。对照组出现 3 例（10%）新发脑卒中，观察组 1 出现 2 例（6.7%）。观察组 2 未出现新发脑卒中。对照组和观察组 1 的美国国立卫生研究院卒中量表（NIHSS）评分在治疗后 6 个月显著下降，但 12 个月时再次升高。相反，观察组 2 的 NIHSS 评分在随访期间持续下降。对照组和观察组 1 的不对称二甲基精氨酸（ADMA）血浆水平逐渐升高，但观察组 2 的 ADMA 水平保持不变。NIHSS 评分和血浆 ADMA 水平在对照组和观察组之间的差异具有统计学意义。
抗癫痫药物联合 B 族维生素可改善脑卒中后癫痫的控制，降低新发脑卒中的发生。这种效果可能与血浆 ADMA 水平的稳定性有关。维生素 B12 治疗脑卒中后癫痫可能优于维生素 B 复合物。
