High-dose versus low-dose valproate for the treatment of juvenile myoclonic epilepsy: Going from low to high.
High-dose versus low-dose valproate for the treatment of juvenile myoclonic epilepsy: Going from low to high.
复制标题
高剂量与低剂量丙戊酸，用于治疗青少年肌阵挛性癫痫：从低到高。
DOI：
10.1016/j.yebeh.2016.04.047
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发表时间：
2016-08
期刊：
影响因子：
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通讯作者：
Martínez-Juárez IE
中科院分区：
文献类型：
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作者：
Hernández-Vanegas LE;Jara-Prado A;Ochoa A;Rodríguez Y Rodríguez N;Durón RM;Crail-Meléndez D;Alonso ME;Delgado-Escueta AV;Martínez-Juárez IE
青少年肌阵挛癫痫(JME)是一种遗传性全身性癫痫，占成人癫痫病例的3-12%。丙戊酸盐已被证明是JME控制最常见的发作类型：肌阵挛、失神和全身性强直-阵挛(GTC)的首选药物。在这项回顾性研究中，我们分析了使用丙戊酸盐单一疗法至少一年的JME患者的癫痫结果。低剂量丙戊酸盐被认为是1000毫克/天或更低，而如果血清浓度低于或等于50微克/分升，则被认为是低水平。103名患者符合纳入标准。女性患者56例(54.4%)。目前平均年龄28.4±7.4岁，癫痫起病年龄13.6±2.9岁。大多数患者对应于经典JME的亚型。46例(44.7%)患者无所有发作类型，76例(73.7%)患者无GTC发作。在使用低剂量丙戊酸盐和高剂量丙戊酸盐的患者之间，或在低血浓度和高血液水平的患者之间，癫痫发作自由程度没有显著差异(p=0.535)。对于JME患者，似乎适宜使用小剂量的丙戊酸盐(500毫克至1,000毫克)作为初始治疗，并进行评估以确定是否获得了癫痫的缓解。
Juvenile myoclonic epilepsy (JME) is a genetic generalized epilepsy accounting for 3–12% of adult cases of epilepsy. Valproate has proven to be the first-choice drug in JME for controlling the most common seizure types: myoclonic, absence, and generalized tonic-clonic (GTC). In this retrospective study, we analyzed seizure outcome in patients with JME using valproate monotherapy for a minimum period of one year. Low valproate dose was considered to be 1000 mg/day or lower, while serum levels were considered to be low if they were at or below 50 mcg/dl. One hundred three patients met the inclusion criteria. Fifty-six patients (54.4%) were female. The current average age was 28.4 ± 7.4 years, while the age of epilepsy onset was 13.6 ± 2.9 years. Most patients corresponded to the subsyndrome of classic JME. Forty-six (44.7%) patients were free from all seizure types, and 76 (73.7%) patients were free from GTC seizures. No significant difference was found in seizure freedom among patients using a low dose of valproate versus a high dose (p=0.535), or among patients with low blood levels versus high blood levels (p=0.69). In patients with JME, it seems appropriate to use low doses of valproate (500 mg to 1,000 mg) for initial treatment and to evaluate to determine if freedom from seizures was attained.