Schapel G J, Black A B, Lam E L, Robinson M, Dollman W B
Department of Neurology, Queen Elizabeth Hospital, Woodville, Australia.
Seizure. 1996 Mar;5(1):51-6. doi: 10.1016/s1059-1311(96)80063-x.
Vigabatrin (GVG) and lamotrigine (LTG) are new antiepileptic drugs (AEDs) individually effective as add-on therapy for refractory seizures. The efficacy of GVG and LTG in combination was evaluated in a prospective audit of 42 patients with intractable epilepsy. There was a statistically significant median reduction of 62% (P < 0.025) from a median baseline monthly seizure frequency (MSF) of 29 (mean 59, 95% CI 22, 96) to a median MSF of 11 (mean 23, 95% CI 8, 38) during a median treatment period of eight months, with a greater than 50% reduction in MSF in 29 patients (69%) treated with the add-on combination of GVG and LTG. The additional MSF reduction achieved by the combination amounted to 21% (18% when GVG was added to LTG and 24% when LTG was added to GVG). The median trough plasma lamotrigine concentration was 9.9 mg/l (range 3.4-19.6 mg/l). The average daily dose of LTG was 517 mg (range, 175-800 mg) and GVG 2400 mg (range, 1500-3500 mg). Adverse events requiring alteration of therapy occurred in 24 patients (57%) with a drop-out rate of 12%. The combination of GVG and LTG should be considered as a therapeutic option in patients with intractable epilepsy. The results of the present study support the need to confirm additive efficacy of GVG and LTG by conducting controlled trials of this combination therapy.
氨己烯酸（GVG）和拉莫三嗪（LTG）是新型抗癫痫药物（AEDs），单独使用时作为难治性癫痫的附加治疗有效。在一项对42例顽固性癫痫患者的前瞻性审核中评估了GVG和LTG联合使用的疗效。在中位治疗期8个月期间，中位基线每月癫痫发作频率（MSF）从29次（平均59次，95%可信区间22, 96）降至中位MSF 11次（平均23次，95%可信区间8, 38），有统计学显著意义的中位数降低了62%（P < 0.025），29例（69%）接受GVG和LTG联合附加治疗的患者MSF降低超过50%。联合使用实现的额外MSF降低为21%（GVG加至LTG时为18%，LTG加至GVG时为24%）。拉莫三嗪的中位谷浓度为9.9 mg/l（范围3.4 - 19.6 mg/l）。LTG的平均日剂量为517 mg（范围175 - 800 mg），GVG为2400 mg（范围1500 - 3500 mg）。24例患者（57%）出现需要改变治疗的不良事件，脱落率为12%。对于顽固性癫痫患者，应考虑将GVG和LTG联合使用作为一种治疗选择。本研究结果支持通过对这种联合治疗进行对照试验来确认GVG和LTG的相加疗效的必要性。
