Mikati M A, Holmes G L
Department of Pediatrics, American University of Beirut, Lebanon.
J Child Neurol. 1997 Nov;12 Suppl 1:S29-37. doi: 10.1177/0883073897012001081.
Although lamotrigine has been approved in the United States as adjunctive therapy for partial seizures in patients older than 12 years, there is increasing evidence that it is just as effective, if not more effective, in the treatment of generalized seizures. A large number of open-label studies and some single-blind data, all using lamotrigine as add-on therapy in patients with previously refractory generalized seizures, are available. Controlled studies, some on newly diagnosed, previously untreated patients with generalized seizures are ongoing. Investigations have demonstrated that patients with the following generalized seizure types improve with lamotrigine add-on therapy: Typical and atypical absence, atonic, generalized tonic-clonic, myoclonic, and clonic seizures. Response rates, defined as the percentage of patients with better than 50% reduction in seizure frequency, have been, depending on seizure type, in the range of 30% to 56%, with 0 to 33% of the patients becoming seizure free. The best responses have been noted in typical and atypical absences, and atonic seizures. Children and adults appear to have comparable responses. In addition, add-on studies in patients with specific, previously refractory, epilepsy syndromes have demonstrated that the best improvement in seizure control occurs in patients with petit mal epilepsy, "other symptomatic" generalized epilepsies, and in Lennox-Gastaut syndrome, followed by patients with other myoclonic epilepsies, myoclonic absence and West syndrome. Many previously refractory patients are able to achieve lamotrigine monotherapy. However, patients with nonprogressive myoclonic epilepsy have little, if any, response. Early data from ambulatory encephalographic (EEG) recordings in patients with previously refractory absence seizures, and from controlled studies on patients with newly diagnosed typical absence seizures, appear to confirm the efficacy of lamotrigine in those patients. Controlled studies are ongoing in patients with absence seizures, in patients with generalized tonic-clonic seizures, and in patients with Lennox-Gastaut syndrome. Dosing in generalized seizures is similar to that for partial seizures. Because of the shorter half-life of lamotrigine in children, as compared to adults, higher (mg/kg) doses are often needed in young patients. We conclude that lamotrigine is a promising drug for absence and primary generalized seizures in both children and adults.
尽管拉莫三嗪在美国已被批准作为12岁以上患者部分性癫痫发作的辅助治疗药物，但越来越多的证据表明，它在治疗全身性癫痫发作方面即便没有更有效，至少也是同样有效的。现有大量开放标签研究以及一些单盲数据，均将拉莫三嗪用作既往难治性全身性癫痫发作患者的附加治疗。针对新诊断的、既往未接受治疗的全身性癫痫发作患者的对照研究正在进行中。调查表明，以下全身性癫痫发作类型的患者在接受拉莫三嗪附加治疗后病情有所改善：典型失神发作和非典型失神发作、失张力发作、全身性强直阵挛发作、肌阵挛发作和阵挛发作。缓解率定义为癫痫发作频率降低超过50%的患者百分比，根据癫痫发作类型不同，缓解率在30%至56%之间，0至33%的患者癫痫发作完全缓解。典型失神发作和非典型失神发作以及失张力发作的缓解情况最佳。儿童和成人的反应似乎相当。此外，针对特定的、既往难治性癫痫综合征患者的附加治疗研究表明，癫痫控制改善最明显的是小儿失神癫痫、“其他症状性”全身性癫痫以及伦诺克斯 - 加斯托综合征患者，其次是其他肌阵挛性癫痫、肌阵挛失神发作和韦斯特综合征患者。许多既往难治的患者能够实现拉莫三嗪单药治疗。然而，非进行性肌阵挛性癫痫患者即便有反应也很轻微。既往难治性失神发作患者动态脑电图（EEG）记录的早期数据以及新诊断的典型失神发作患者的对照研究数据，似乎证实了拉莫三嗪对这些患者的疗效。针对失神发作患者、全身性强直阵挛发作患者以及伦诺克斯 - 加斯托综合征患者的对照研究正在进行中。全身性癫痫发作的给药方式与部分性癫痫发作相似。由于与成人相比，拉莫三嗪在儿童体内的半衰期较短，因此年轻患者通常需要更高（mg/kg）剂量。我们得出结论，拉莫三嗪对于儿童和成人的失神发作及原发性全身性癫痫发作都是一种有前景的药物。
