癫痫杂志

癫痫杂志

癫痫伴慢波睡眠期持续棘慢波(CSWS)患者的治疗:北美治疗选择的调查

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现有文献没能为癫痫伴慢波睡眠期持续棘慢波(Continuous spikes and waves during sleep, CSWS)患者的治疗方法提供充分的证据。文章的目的在于描述北美临床医生在面对CSWS患者时做出的治疗选择。在美国癫痫学会(American Epilepsy Society, AES)成员中进行了关于CSWS治疗选择的问卷调查, 调查包含24项题目。问卷中描述了CSWS的治疗临床情境。题目询问的是在该临床情境下的治疗选择。被调查人通过在线调查网站(www.surveymonkey.com)自行填写问卷收集。完成问卷共计232份, 81%的调查对象认为明显的睡眠棘波增强应当治疗。睡眠棘波增强在经过有效治疗之后, 调查对象表示16%的患者的认知功能有>75%的改善, 52%的患者有25%~75%的改善, 20%的患者有 < 25%的改善, 还有12%的调查对象称患者的认知功能并没有明确的改变。减少睡眠诱发的痫样放电增强的首选疗法分别为:高剂量苯二氮类药物(47%)、丙戊酸(26%)和皮质类固醇(15%)。次选疗法分别为:丙戊酸(26%)、高剂量苯二氮卓类药物(24%)和皮质类固醇(23%)。在高剂量苯二氮卓类药物中, 最常用的是地西泮, 第一夜用1 mg/kg, 之后用0.5 mg/(kg·d)。丙戊酸的常用剂量为30~49 mg/(kg·d)。在皮质类固醇中, 最常用的是口服泼尼松2 mg/(kg·d)。终止治疗的疗效指标有(从强到弱排列):脑电图上癫痫样放电的相应改变、认知功能好转、发作减少。在培训水平及临床经验不同的调查对象中, 结果是一致的。在儿童和成人神经科医生之间, 存在着概念和治疗方法的差异。大部分临床医生认为睡眠期明显增强的痫样放电是应当治疗的。调查对象们没有就最佳疗法的问题达成一致, 但可选疗法包括了:高剂量苯二氮卓类药物、丙戊酸、左乙拉西坦和皮质类固醇。

关键词: 抗癫痫药物; 脑电图; 癫痫; 癫痫发作; 睡眠; 治疗

引用本文: SánchezFernández I, ChapmanK, PetersJM, KlehmJ, JacksonMC, BergAT, LoddenkemperT. 癫痫伴慢波睡眠期持续棘慢波(CSWS)患者的治疗:北美治疗选择的调查. 癫痫杂志, 2016, 2(5): 446-453. doi: 10.7507/2096-0247.20160080 复制

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