不同剂量丙戊酸联合拉莫三嗪对老年癫痫患者脑电图的影响

摘要

目的 观察不同剂量丙戊酸联合拉莫三嗪治疗老年癫痫患者的疗效及对脑电图的影响.方法选取我院2015年1月至2017年10月收治的102例老年癫痫患者,按随机数表法分为对照组、常规剂量组、小剂量组,每组34例.对照组单独采用丙戊酸钠缓释片进行治疗,常规剂量组采取常规剂量丙戊酸[20～30 mg/(kg/d)]联合拉莫三嗪进行治疗,小剂量组采取小剂量丙戊酸[10～15 mg/(kg·d)]联合拉莫三嗪进行治疗.比较三组治疗前3个月内与治疗后3个月内的发作次数与发作持续时间、总有效率、治疗前后的脑电图痫样放电与累及导联数、不良反应总发生率.结果 三组治疗前的发作次数、发作持续时间比较差异无统计学意义(P＞0.05);治疗后,三组的发作次数减少,发作持续时间缩短,差异均有统计学意义(P ＜0.05).常规剂量组与小剂量组治疗后的发作次数少于对照组,且发作持续时间较对照组缩短,差异均有统计学意义(P ＜0.05).常规剂量组与小剂量组的总有效率分别为94.12％、91.18％,高于对照组的70.59％,差异有统计学意义(P ＜0.05).三组治疗前的痫样放电与累及导联数比较差异无统计学意义(P＞ 0.05);治疗后,三组的痫样放电与累及导联数较治疗前减少,差异有统计学意义(P ＜0.05).常规剂量组与小剂量组治疗后的痫样放电与累及导联数少于对照组,差异有统计学意义(P ＜0.05).对照组与小剂量组的不良反应总发生率为8.82％、11.76％,低于常规剂量组的29.41％,差异有统计学意义(P ＜0.05).结论 丙戊酸联合拉莫三嗪可有效减少癫痫发作并改善脑电图,疗效优于丙戊酸单药治疗,其中小剂量丙戊酸联合拉莫三嗪可进一步减少不良反应,值得推广.%Objective To observe the efficacy of different doses of valproic acid combined with lamotrigine in the treatment of elderly patients with epilepsy and its effect on electroencephalography. Methods A total of 102 elderly patients with epilepsy admitted to our hospital fromJanuary 2015 to October 2017 were selected and divided into control group, conventional-dose group, and low-dose group according to the randomnumber table method, with 34 cases in each group. Control group was treated with sodiumvalproate sustained-release tablet alone. Conventional-dose group was treated with a conventional dose of valproic acid [20 ～ 30 mg/ (kg·d) ] combined with lamotrigine. Low-dose group was given a small dose of valproic acid [10 ～ 15 mg/ (kg·d) ]combined with lamotrigine. The seizure frequency and duration of seizures within 3 months before treatment and within 3 months after treatment, total effective rate, the epileptiformdischarge and number of leads involved of electroencephalogrambefore and after treatment, and the total adverse reaction rate were compared among the three groups. Results There were no significant difference in seizure frequency or duration of seizures before treatment in the three groups (P＞ 0. 05). After treatment, the seizure frequency and duration of seizures in the three groups were decreased significantly (P ＜ 0. 05). The seizure frequency after treatment in conventional-dose group and low-dose group were lower than those in control group (P ＜ 0. 05), and the daration of seizures was shorter (P ＜ 0. 05). The total effective rate of conventional-dose group and low-dose group was 94. 12％ and 91. 18％, respectively, which was higher than 70. 59％ of control group (P ＜ 0. 05). There were no significant differences in the epileptiformdischarge or number of leads involved among the three groups (P＞ 0. 05).After treatment, the epileptiformdischarge and number of leads involved in the three groups were decreased (P ＜0. 05). The epileptiformdischarge and number of leads involved in conventional-dose group and low-dose group were lower than those in control group (P ＜ 0. 05). The overall incidence of adverse reactions in control group and low-dose group was 8. 82％ and 11. 76％, which was lower than 29. 41％ in conventional-dose group (P ＜ 0. 05). Conclusion Valproic acid combined with lamotrigine is effective in reducing seizures and improving electroencephalogram, and the curative effect is better than valproic acid monotherapy. Low-dose valproic acid combined with lamotrigine can further reduce the adverse reactions, which is worthy of promotion.