Semah F, Gimenez F, Longer E, Laplane D, Thuillier A, Baulac M
Clinique Neurologique Paul Castaigne, Hôpital de la Salpétrière, Paris, France.
Ther Drug Monit. 1994 Dec;16(6):537-40.
We evaluated the efficacy, development of adverse effects, and possible correlation between the plasma concentration of carbamazepine (CBZ) and its major metabolite, carbamazepine-10,11-epoxide (CBZ-E), in a group of epileptic patients in whom selective increases in CBZ doses were made. Eighteen patients with refractory partial epilepsy participated in an open trial. Five were on monotherapy and 13 on polytherapy. All the patients were on CBZ before the trial and had plasma levels within the therapeutic range (17-42 mumol/L). After a baseline period, CBZ doses were progressively increased either to reach a 50% reduction in seizure frequency for 2 months or until side effects appeared. Thirty-nine percent of the patients had a 50% decline in seizure frequency, but only 17% improved for > 6 months. Mild or moderate side effects were observed in 78% of the patients. Side effects were correlated with CBZ plasma levels but not with CBZ-E plasma levels. Correlation between CBZ and CBZ-E plasma levels were found in the monotherapy group, but not in the polytherapy group. Our results confirm that higher doses of CBZ can successfully be used in some patients with refractory partial epilepsy. Furthermore, the plasma level of CBZ-E does not seem to be a useful indicator of toxicity in CBZ-treated ambulatory epileptic patients.
我们对一组癫痫患者进行了评估，这些患者选择性地增加了卡马西平（CBZ）的剂量，以观察其疗效、不良反应的发生情况以及CBZ血浆浓度与其主要代谢产物卡马西平 - 10,11 - 环氧化物（CBZ - E）之间可能存在的相关性。18例难治性部分性癫痫患者参与了一项开放试验。其中5例接受单一疗法，13例接受联合疗法。所有患者在试验前均服用CBZ，且血浆水平在治疗范围内（17 - 42 μmol/L）。在基线期后，逐渐增加CBZ剂量，要么使癫痫发作频率降低50%并持续2个月，要么直至出现副作用。39%的患者癫痫发作频率下降了50%，但只有17%的患者改善持续超过6个月。78%的患者观察到轻度或中度副作用。副作用与CBZ血浆水平相关，但与CBZ - E血浆水平无关。在单一疗法组中发现了CBZ与CBZ - E血浆水平之间的相关性，但在联合疗法组中未发现。我们的结果证实，更高剂量的CBZ可成功用于一些难治性部分性癫痫患者。此外，对于接受CBZ治疗的门诊癫痫患者，CBZ - E的血浆水平似乎并非毒性的有用指标。
