丙戊酸钠联合左乙拉西坦治疗脑卒中后癫痫的临床观察

摘要

目的：观察丙戊酸钠联合左乙拉西坦治疗脑卒中后癫痫的疗效和安全性。方法：84例脑卒中后癫痫患者随机分为对照组（42例）和观察组（42例）。两组患者均给予降血脂、降血压、改善微循环、降低颅内压、抗凝、抗血小板聚集及脑神经保护药等常规治疗，对于癫痫持续状态患者酌情给予地西泮控制症状。在此基础上，对照组患者口服丙戊酸钠缓释片15～20 mg/（kg·d），每日3次，连用7 d，若症状得到控制则维持此剂量；若症状未得到控制则增加剂量至20～30 mg/（kg·d），每日3次。观察组患者在对照组治疗的基础上口服左乙拉西坦片初始剂量0.25 g，每日2次，连用7 d后增加剂量至0.5 g，每日2次，若症状得到控制则维持此剂量；若症状未得到控制则增加剂量至3 g，每日2次。两组患者均连续用药12个月，后每周减少左乙拉西坦片0.25 g至完全停药，对于停药后复发者需终身用药。观察两组患者的临床疗效、治疗前后癫痫发作次数、发作持续时间、痫样放电、累及导联数、神经元特异性烯醇化酶（NSE）、肿瘤坏死因子（TNF）-α、白细胞介素（IL）-2、IL-6水平及不良反应发生情况。结果：观察组患者总有效率显著高于对照组，差异有统计学意义（P＜0.05）。治疗前，两组患者癫痫发作次数、发作持续时间、痫样放电、累及导联数、NSE、TNF-α、IL-2、IL-6水平比较，差异均无统计学意义（P＞0.05）。治疗后，两组患者癫痫发作次数、发作持续时间、痫样放电、累及导联数、NSE、TNF-α、IL-2、IL-6水平均显著低于同组治疗前，且观察组低于对照组，差异均有统计学意义（P＜0.05）。两组患者不良反应发生率比较差异无统计学意义（P＞0.05）。结论：在常规治疗的基础上，丙戊酸钠联合左乙拉西坦治疗脑卒中后癫痫的疗效显著优于单用丙戊酸钠，且不增加不良反应的发生。%OBJECTIVE:To observe the efficacy and safety of sodium valproate combined with levetiracetam in the treatment of post-stroke epilepsy. METHODS:84 patients with post-stroke epilepsy were randomly divided into control group (42 cases) and observation group(42 cases). All patients were given lowering lipid,lowering blood pressure,improving microcirculation,re-ducing intracranial pressure,anticoagulation,anti-platelet aggregation,cranial nerve protection and other conventional treatment, patients with status epilepticus were given stability control symptoms. Based on it,control group orally received Sodium valproate sustained-release tablet 15-20 mg/(kg·d),3 times a day,for 7 d,maintaining the dose if symptom was controlled;the dose in-creased to 20-30 mg/(kg·d)if it was not controlled,3 times a day. Observation group was additionally received Levetiracetam tab-let with initial dose of 0.25 g,twice a day,increased to 0.5 g after 7 d,maintaining the dose if symptom was controlled;then in-creased to 3 g if symptom was not controlled,twice a day. 2 groups of patients were continuous treated for 12 months,then de-creased Levetiracetam tablet 0.25 g weekly until complete withdrawal,patients with recurrence required lifelong medication. The clinical observation,times of seizures,seizure duration,epileptiform discharges,involved lead number,serum neuron specific eno-lase(NSE),TNF-α,IL-2 and IL-6 before and after treatment,the incidence of adverse reactions in 2 groups were observed. RE-SULTS:The total effective rate in observation group was significantly higher than control group,with statistical significance(P0.05). After treatment,the times of seizures,seizure du-ration,epileptiform discharges,involved lead number,NSE,TNF-α,IL-2 and IL-6 levels in 2 groups were significantly lower than before,and observation group was lower than control group,with statistical significances(P0.05). CONCLUSIONS:Based on conventional treatment,the effi-cacy of sodium valproate combined with levetiracetam is significantly superior to sodium valproate alone in the treatment of post-stroke epilepsy,and do not increase the indence of adverse reactions.