Kanemura Hideaki, Sano Fumikazu, Ohyama Tetsuo, Sugita Kanji, Aihara Masao
Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
Graduate Faculty of Interdisciplinary Research, University of Yamanashi, Yamanashi, Japan.
Neuropediatrics. 2018 Apr;49(2):135-141. doi: 10.1055/s-0037-1613680. Epub 2017 Dec 18.
This article compares the efficacy and tolerability of carbamazepine (CBZ) and levetiracetam (LEV) when used as initial monotherapy in children with nonlesional focal epilepsy. Patients with nonlesional focal epilepsy were subdivided into two groups according to the initial monotherapy: a LEV group administered LEV at an initial dose of 5 mg/kg/day and a CBZ group. Seizure response, adverse events, medication dose, reasons for discontinuing medication, adherence, and random serum levels were recorded. The overall percentage of patients who failed initial treatment and reasons for each treatment failure were determined. Data were analyzed from 183 children who received CBZ monotherapy and 46 children who received LEV monotherapy for ≥12 months. Overall, 126 patients (68.9%) became seizure-free with CBZ, compared with 37 patients (80.4%) with LEV. Moreover, four patients in CBZ and four patients in LEV groups showed a >50% reduction in seizure frequency. The efficacy rate was significantly higher and the adverse event rate was significantly lower in the LEV group than in the CBZ group ( = 0.0129 and = 0.0039, respectively). LEV may offer superior efficacy and a lower risk of adverse effects compared with CBZ. LEV as initial monotherapy may represent a valuable treatment option for children with nonlesional focal childhood epilepsy.
本文比较了卡马西平（CBZ）和左乙拉西坦（LEV）作为初治单药疗法用于非病灶性局灶性癫痫患儿时的疗效和耐受性。将非病灶性局灶性癫痫患者根据初始单药疗法分为两组：左乙拉西坦组初始剂量为5mg/kg/天给予左乙拉西坦，以及卡马西平组。记录癫痫发作反应、不良事件、药物剂量、停药原因、依从性和随机血清水平。确定初始治疗失败的患者总体百分比以及每次治疗失败的原因。对183例接受卡马西平单药治疗且46例接受左乙拉西坦单药治疗≥12个月的儿童的数据进行分析。总体而言，卡马西平治疗后126例患者（68.9%）无癫痫发作，而左乙拉西坦治疗后为37例患者（80.4%）。此外，卡马西平组4例患者和左乙拉西坦组4例患者癫痫发作频率降低>50%。左乙拉西坦组的有效率显著高于卡马西平组，不良事件发生率显著低于卡马西平组（分别为=0.0129和=0.0039）。与卡马西平相比，左乙拉西坦可能具有更高的疗效和更低的不良反应风险。左乙拉西坦作为初始单药疗法可能是儿童非病灶性局灶性癫痫的一种有价值的治疗选择。
