癫痫杂志

癫痫杂志

大剂量泼尼松治疗婴儿痉挛症的优化方案

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目的对大剂量泼尼松联合托吡酯(Topiramate, TPM)治疗婴儿痉挛症(Infantile spasms, IS)的治疗方案进行优化。 方法收集2012年9月-2013年9月江西省儿童医院神经内科符合IS诊断标准的住院患儿60例,随机分为对照组和试验组各30例,至少随访6个月以上。所有患儿均于治疗前和治疗2周及疗程结束时进行视频脑电图(VEEG)监测;同时于治疗前和治疗6个月时进行Gesell发育测试。 结果泼尼松治疗第1周无效的病例,在第2周和疗程结束时试验组的痉挛控制率分别是46.67%和60.00%,高于对照组的31.25%和37.50%,但差异无统计学意义(P >0.05);同时试验组的高度失律缓解率分别是46.67%和60.00%,也高于对照组的25.00%和37.50%,差异也无统计学意义(P >0.05)。试验和对照组不良反应的发生率(83.33% vs. 80.00%),复发率(39.14% vs. 40.00%),两组间比较无统计学差异(P >0.05)。在治疗2周及疗程结束时,无论试验组还是对照组,病程在2个月内的患儿痉挛控制率均明显高于病程2个月以上者(P<0.05)。 结论试验组的治疗方案优于对照组,早期诊断、早期治疗可以显著提供疗效,对IS的发作控制和高度失律的缓解均具有重要影响。

ObjectiveTo optimize the therapy protocols of high dose prednisone combined with topiramate (TPM) in children with infantile spasms (IS). MethodsSixty cases were collected in our hospital from September 2012 to September 2013 and randomly divided into two groups(n=30) and followed-up for more than 6 months.The spasms were assesses by video-electroencephalogram (VEEG) monitoring including awake and asleep states before treatment, after two weeks of therapy and the end of the courses respectively.And the Gessel developmental quotient (DQ) scores were performed before treatment and after six months of therapy. ResultsFor the unresponders to high dose prednisone in one week of therapy, there were 46.67%and 60.00% in test group higher than 31.25% and 37.50% in control group respectively in 2 week and in the end of treatment.And the rate of complete resolution of hypsarrhythmia in the test group was 46.67% and 60.00% higher than 25.00% and 37.50% in control group respectively in 2 week and in the end of treatment.But there were no statistical significances between two groups(P >0.05).The incidence of side effects(83.33% vs. 80.00%) and the relapse rate(39.14% vs. 40.00%), were not statistically significant between two groups(P >0.05).The responsive rates for the cases with the lead time within 2 months higher than beyond 2 months in two groups respectively in 2 weeks and in the end of treatment. ConclusionsThe protocol of the test group was superior to that of the control group.The responsive rates of children within 2 months of lead time were higher than beyond 2 months, which indicates that early diagnosis and early treatment would improve efficacy and have an important influence on the prognosis of IS.

关键词: 婴儿痉挛症; 高度失律; 泼尼松; 托吡酯; 疗效; 安全性

Key words: Infantile spasms; Hypsarrhythmia; Prednisone; Topiramate; Efficacy; Safety

引用本文: 查剑, 曾兴颖, 易招师, 虞雄鹰, 吴华平, 陈勇, 钟建民. 大剂量泼尼松治疗婴儿痉挛症的优化方案. 癫痫杂志, 2017, 3(3): 193-198. doi: 10.7507/2096-0247.20170029 复制

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1. Mackay MT, Weiss SK, Adams-Webber T, et al.Practice parameter:medical treatment of infantile spasms:report of the american academy of neurology and the child neurology society.Neurology, 2004, 62(10):1668-1681.
2. Riikonen R.A European perspective-comments on"Infantile spasms:a U.S.consensus report".Epilepsia, 2010, 51(10):2215-2216; author reply 2221.
3. Pellock JM, Hrachovy R, Shinnar S, et al.Infantile spasms:a U.S.consensus report.Epilepsia, 2010, 51(10):2175-2189.
4. 中国抗癫痫协会.临床诊疗指南·癫痫病分册.第2版.北京:人民卫生出版社, 2015:35-54.
5. Arya R, Shinnar S, Glauser TA.Corticosteroids for the treatment of infantile spasms:a systematic review.J Child Neurol, 2012, 27(10):1284-1288.
6. Hancock EC, Osborne JP, Edwards SW.Treatment of infantile spasms.Cochrane Database Syst Rev, 2013, 6:CD001770
7. Riikonen R.Recent advances in the pharmacotherapy of infantile spasms.CNS Drugs, 2014, 28(4):279-290.
8. Thodeson D, Sogawa Y.Practice experience in the treatment of infantile spasms at a tertiary care center.Pediatr Neurol, 2014, 51(5):696-700.
9. Wilmshurst JM, Gaillard WD, Vinayan KP, et al.Summary of recommendations for the management of infantile seizures:Task Force Report for the ILAE Commission of Pediatrics.Epilepsia, 2015, 56(8):1185-1197.
10. Lux AL, Edwards SW, Hancock E, et al.The United Kingdom infantile spasms study comparing vigabatrin with prednisolone or tetracosactide at 14 days:a multicentre, randomised controlled trial.Lancet, 2004, 364(9447):1773-1778.
11. Hussain SA, Shinnar S, Kwong G, et al.Treatment of infantile spasms with very high dose prednisolone before high dose adrenocorticotropic hormone.Epilepsia, 2014, 55(1):103-107.
12. Kossoff EH, Hartman AL, Rubenstein JE.High-dose oral prednisolone for infantile spasms:An effective and less expensive alternative to ACTH.Epilepsy & Behavior, 2009, 14(4):674-676.
13. 易招师, 查剑, 钟建民, 等.不同剂量泼尼松联合托吡酯治疗婴儿痉挛的疗效及安全性.中华实用儿科临床杂志, 2014, 29(2): 137-140.
14. Mohamed BP, Scott RC, Desai N, et al.Seizure outcome in infantile spasms--a retrospective study.Epilepsia, 2011, 52(4): 746-752.
15. 易招师, 吴华平, 虞雄鹰, 等.大剂量泼尼松治疗婴儿痉挛患儿脑电图变化的观察.癫痫与神经电生理学杂志, 2012, 21(4): 208-214.
16. 廖建湘.婴儿痉挛症的诊断与治疗.实用儿科临床杂志, 2008, 23(24): 1934-1936.
17. Watemberg N.Infantile spasms:treatment challenges.Curr Treat Options Neurol, 2012, 14(4):322-331.
18. 钟建民.肾上腺皮质激素在儿科癫痫中的应用.国际儿科学杂志, 2013, 40(5): 522-525.
19. O'callaghan FJ, Lux AL, Darke K, et al.The effect of Lead time to treatment and of age of onset on developmental outcome at 4 years in infantile spasms:evidence from the United kingdom Infantile spasms study.Epilepsia, 2011, 52(7):1359-1364.
20. Go CY, Mackay MT, Weiss SK, et al.Evidence-based guideline update:medical treatment of infantile spasms.Report of the guideline development subcommittee of the american academy of neurology and the practice committee of the child neurology society.Neurology, 2012, 78(24):1974-1980.