Lamotrigine and seizure aggravation in severe myoclonic epilepsy
Lamotrigine and seizure aggravation in severe myoclonic epilepsy
复制标题
DOI：
10.1111/j.1528-1157.1998.tb01413.x
复制
发表时间：
1998-05-01
期刊：
影响因子：
5.6
通讯作者：
Dulac, O
中科院分区：
文献类型：
--
作者：
Guerrini, R;Dravet, C;Dulac, O
目的：在婴儿期严重肌阵挛癫痫 (SME) 中，会出现多种耐药性局灶性和全身性癫痫类型。拉莫三嗪（LTG）被发现对许多全身性和部分性癫痫发作有效，但很少用于治疗具有多种癫痫类型的严重儿童癫痫综合征。我们研究了LTG对SME的影响。方法：21例2-18岁的SME患者接受LTG治疗，其中20例为附加疗法，1例为单一疗法。 LTG 开始剂量为 0.2-2.5 mg/kg/天，然后增加至 2.5-12.5 mg/kg/天。对于每种癫痫类型，排除非典型失神，与 2 个月前的 LTG 相比，>50% 的变化被认为是反应指标，同时还考虑到每种癫痫类型产生的残疾程度。 结果：LTG 导致 17 名患者 (80%) 病情恶化，3 名患者无变化，1 名患者有所改善。 20 名患者中有 8 名（40%）惊厥发作增加了 50% 以上。 18 名患者中有 6 名（33%）肌阵挛发作恶化。在至少一种癫痫发作类型有所改善的五名患者中，四名患者同时出现更多无效癫痫发作的恶化。大多数患者在 3 个月内出现明显的病情恶化，但也有一些患者病情恶化。 19 名患者在 15 天至 5 年（平均 14 个月）后暂停 LTG，其中 18 名患者随后得到改善。 结论：LTG 治疗期间癫痫发作明显恶化并非归因于疾病的自然病程，而可能是治疗性 LTG 剂量的直接影响。 LTG 治疗似乎不适合中小企业。
Purpose: In severe myoclonic epilepsy of infancy (SME), multiple drug-resistant focal and generalized seizure types occur. Lamotrigine (LTG), found effective in many generalized and partial seizures, has been little used in severe childhood epilepsy syndromes with multiple seizure types. We studied the effects of LTG in SME.Methods: Twenty-one patients with SME, aged 2-18 years, were treated with LTG, 20 in add-on and one in monotherapy. LTG was started at 0.2-2.5 mg/kg/day and increased to 2.5-12.5 mg/kg/day. For each seizure type, excluding atypical absences, >50% variations compared with the 2 months preceding LTG were considered indicators of response, also taking into account the degree of disability each seizure type produced.Results: LTG induced worsening in 17 (80%) patients, no change in three, and improvement in one. There was >50% increase in convulsive seizures in eight (40%) in 20 patients. Myoclonic seizures worsened in six (33%) of 18 patients. Of five patients improving in at least one seizure type, four had concomitant worsening of more invalidating seizures. Clear-cut worsening appeared within 3 months in most patients but was insidious in some. LTG was suspended in 19 patients after 15 days-5 years (mean, 14 months) with consequent improvement in 18.Conclusions: The pronounced seizure deterioration during LTG treatment was not attributable to the natural course of the disease and could be a direct effect of therapeutic LTG doses. LTG treatment seems inappropriate in SME.