New onset geriatric epilepsy - A randomized study of gabapentin, lamotrigine, and carbamazepine
New onset geriatric epilepsy - A randomized study of gabapentin, lamotrigine, and carbamazepine
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DOI：
10.1212/01.wnl.0000167384.68207.3e
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发表时间：
2005-06-14
期刊：
影响因子：
9.9
通讯作者：
Tomyanovich, ML
中科院分区：
文献类型：
--
作者：
Rowan, AJ;Ramsay, RE;Tomyanovich, ML
目的：确定两种新型抗癫痫药物拉莫三嗪 (LTG) 和加巴喷丁 (GBP) 与卡马西平 (CBZ) 相比，在老年癫痫患者中的相对耐受性和疗效。方法：这是一项 18 中心、随机、双盲、双模拟、平行研究，受试者为 593 名新诊断癫痫发作的老年受试者。患者被随机分配到三个治疗组之一：GBP 1,500 mg/天、LTG 150 mg/天、CBZ 600 mg/天。主要结果指标是 12 个月的试验保留率。结果：平均年龄为 72 岁。最常见的病因是脑梗塞。患者患有多种疾病，平均服用七种药物。 6周时的平均血浆水平如下：GBP 8.67+/-4.83μg/mL，LTG 2.87+/-1.60μg/mL，CBZ 6.79+/-2.92μg/mL。他们在整个审判过程中保持稳定。提前终止：LTG 44.2 %，GBP 51 %，CBZ 64.5 % (p = 0.0002)。显着配对比较：LTG 与 CBZ：p < 0.0001；英镑兑 CBZ：p = 0.008。因不良事件而终止：LTG 12.1 %、GBP 21.6 %、CBZ 31 % (p = 0.001)。显着配对比较：LTG 与 CBZ：p < 0.0001； LTG 与英镑：p < 0.015。 12 个月时无癫痫发作率没有显着差异。结论：药物不良反应是患者保留的主要限制因素。服用拉莫三嗪 (LTG) 或加巴喷丁 (GBP) 的患者比服用卡马西平的患者效果更好。各组之间的癫痫发作控制相似。 LTG 和 GBP 应被视为新诊断癫痫发作的老年患者的初始治疗。
Objective: To determine the relative tolerability and efficacy of two newer antiepileptic drugs, lamotrigine (LTG) and gabapentin (GBP), as compared to carbamazepine (CBZ) in older patients with epilepsy. Methods: This was an 18-center, randomized, double-blind, double dummy, parallel study of 593 elderly subjects with newly diagnosed seizures. Patients were randomly assigned to one of three treatment groups: GBP 1,500 mg/day, LTG 150 mg/day, CBZ 600 mg/ day. The primary outcome measure was retention in trial for 12 months. Results: Mean age was 72 years. The most common etiology was cerebral infarction. Patients had multiple medical conditions and took an average of seven comedications. Mean plasma levels at 6 weeks were as follows: GBP 8.67 +/- 4.83 mu g/mL, LTG 2.87 +/- 1.60 mu g/mL, CBZ 6.79 +/- 2.92 mu g/mL. They remained stable throughout the trial. Early terminations: LTG 44.2 %, GBP 51 %, CBZ 64.5 % (p = 0.0002). Significant paired comparisons: LTG vs CBZ: p < 0.0001; GBP vs CBZ: p = 0.008. Terminations for adverse events: LTG 12.1 %, GBP 21.6 %, CBZ 31 % (p = 0.001). Significant paired comparisons: LTG vs CBZ: p < 0.0001; LTG vs GBP: p < 0.015. There were no significant differences in seizure free rate at 12 months. Conclusions: The main limiting factor in patient retention was adverse drug reactions. Patients taking lamotrigine ( LTG) or gabapentin ( GBP) did better than those taking carbamazepine. Seizure control was similar among groups. LTG and GBP should be considered as initial therapy for older patients with newly diagnosed seizures.