拉莫三嗪对部分性发作癫痫患者认知功能及生活质量的影响

摘要

目的 评价拉莫三嗪(LTG)对部分性发作癫痫患者认知功能以及生活质量的影响.方法 对26例新诊断的部分性发作的癫痫患者随机分为两组,LTG组14例,给予LTG治疗,卡马西平(CBZ)组12例,给予CBZ治疗,在用药前及用药后16周进行认知功能评定及生活质量调查.认知功能评定包括数字广度,词语流畅、连线测验(A、B型)、Stroop字色干扰测验、威斯康星卡片分类测验(WCST)、延迟逻辑记忆、延迟视觉记忆、计算力、数字符号转换测验;生活质量调查采用癫痫患者生活质量评定量表-31(QOLIE-31). 结果癫痫患者应用LTG治疗16周后认知功能与用药前比较词语流畅性增加,A型、B型连线测验时间缩短,WCST正确数、分类数增加,持续错误、操作时间减少,数字符号转换测验增加,延迟逻辑记忆增加,延迟视觉记忆增加,均有统计学意义(t=3.043、-3.287、-2.543、3.167、3.028、-2.191、-3.216、3.061、3.036、3.021,P<0.01或P<0.05).两组治疗前后差值比较,LTG组比CBZ组Stroop读色时间减少,数字符号转换测验增加,计算力增加,差异均有统计学意义(t=3.167、2.142、2.101,P<0.01或P<0.05).QOLIE-31调查结果显示,与治疗前比较,LTG组和CBZ组治疗后综合生活质量、总体健康水平、认知功能、社会功能得分均增加(LTG组:t=3.321、2.462、3.294、3.512;CBZ组:t=3.314、3.149、3.294、3.202;P<0.01或P<0.05);LTG组与CBZ组治疗前后差值比较,认知功能、社会功能明显改善(t=2.257、2.140,均P<0.05),对发作的担心也减少(t=2.147、P<0.05). 结论 拉莫三嗪能够改善新诊断的部分性发作的癫痫患者认知功能,并提高生活质量.%Objective To explore the effects of lamotrigine (LTG) on cognitive function and the quality of life (QOL) in patients with partial epilepsy. Methods Twenty six patients with newly diagnosed partial epilepsy were randomly divided into 2 different groups using oral administration of LTG and carbamazepine (CBZ) respectively. By neuropsychological test scores and the Quality of Life in Epilepsy Inventory (QOLIE-31) The cognitive function and QOL were assessed before and 16 weeks after the treatment. A battery of neuropsychological tests comprised WAIS digital span test (WDST), verbal fluency test (VFT), trail making test (TMT, parts A and B), stroop color word test (SCWT), Wisconsin card sorting test (WCST), delayed logical memory test, delayed optical memory test, arithmetic ability and digital symbol conversion test. Results The repeated assessments for the patients taking LTG were associated with significant improvements in many domains. When comparing the results at the end of 16 weeks with the baseline results, the verbal fluency were improved, the time of trail making test parts A and B were shortened, the WCST correct number and classification were improved, and the persistent error number and operation time of WCST were declined as well, digital symbol conversion was increased, delayed logic memory and optical memory were improved (t=3. 043, -3. 287,-2. 543,3. 167,3. 028,-2. 191, -3. 216,3. 061,3. 036, 3. 021 ,all P<0. 01 or P<0. 05). When comparing the efficacy of LTG with the CBZ group, the time of stroop color word test was shortened, digital symbol conversion was increased and arithmetic ability was improved (t= 3. 167,2. 142,2. 101, P<0.01 or P<0. 05). Compared with the baseline, both LTG group and CBZ group showed that the overall QOL, overall health, cognitive function and social function scores were improved (LTG group: t= 3. 321,2. 462,3. 294,3. 512;CBZ group: t=3. 314, 3. 149,3. 294,3. 202,all P<0.05). When comparing LTG group with CBZ group after therapy, cognitive function and social function scores were obviously improved (t = 2. 257,2. 140, both P< 0. 05), and the worry about seizure declined (t=2. 147,P<0. 05). Conclusions LTG may improve the cognitive function and QOL in patients with newly diagnosed partial epilepsy.