小剂量拉莫三嗪联合丙戊酸完全控制新诊断癫痫后转为拉莫三嗪单药治疗的可行性研究
Feasibility of conversion to lamotrigine monotherapy after complete control of newly diagnosed epilepsy by low-dose lamotrigine combined with valproic acid

冒文娟.小剂量拉莫三嗪联合丙戊酸完全控制新诊断癫痫后转为拉莫三嗪单药治疗的可行性研究[J].内科急危重症杂志,2019,25(3):189-191

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DOI：10.11768/nkjwzzzz20190304

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作者	单位	E-mail
冒文娟	新疆维吾尔自治区人民医院	pzd773270748@163.com

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中文摘要:

目的：探讨小剂量拉莫三嗪（LTG）联合丙戊酸（VPA）完全控制新诊断癫痫后转为拉莫三嗪单药治疗的可行性。方法：选择经小剂量LTG联合VPA治疗6个月后癫痫发作完全控制的50例患者，均逐渐停VPA，应用LTG单药治疗。记录患者6个月内癫痫发作次数及频率，治疗不良反应发生率，测定停用VPA7d、LTG单药治疗前、LTG单药治疗6个月后患者空腹血糖、胰岛素、体重的变化，计算胰岛素抵抗指数（HOMA-IR）与身体质量指数（BMI），检测LTG血药浓度的变化，监测患者脑电图的改变。结果： ①本组47例完成6个月随访，其中LTG单药治疗后有6例（12.77%）癫痫发作。②VPA停用7d、LTG单药治疗6个月后所有患者BMI\[（20.97±1.2）kg/m2、（20.03±0.29）kg/m2\]、HOMA-IR均降低\[（1.22±0.36）、（1.01±0.11）\]，治疗不同时间比较，差异有统计学意义（P<0.05）。③LTG单药治疗前患者LTG血药浓度高于VPA停用7d（P<0.05），而VPA停用7d、LTG单药治疗6个月患者LTG血药浓度比较,差异无统计学意义（P>0.05）。④LTG单药治疗6个月，癫痫发作与未发作患者LTG血药浓度比较，差异无统计学意义（P>0.05）。结论：对小剂量LTG联合VPA治疗完全控制的新诊断癫痫患者转为LTG单药治疗，患者复发率低，疗效稳定，患者胰岛素抵抗减轻，安全性高，且LTG血药浓度无明显变化。

英文摘要:

Objective: To investigate the feasibility of lamotrigine monotherapy after complete control of newly diagnosed epilepsy with low-dose lamotrigine (LTG) combined with valproic acid (VPA). Methods: A total of 50 patients with epilepsy completely controlled by 6 months of treatment with low-dose LTG combined with VPA were enrolled in the study. VPA was stopped gradually and LTG monotherapy was adopted. The times and frequency of epilepsy seizure within 6 months were recorded and the incidence of adverse reactions was statistically analyzed. The changes of fasting blood glucose, insulin and body weight at 7d of VPA withdrawal, before and 6 months after LTG monotherapy were measured. The insulin resistance index (HOMA-IR) and body mass index (BMI) were calculated. Changes of LTG blood concentration were detected. EEG changes were monitored. Results: ①All 47 cases were followed up for 6 months. Epilepsy occurred in 6 cases after LTG monotherapy (12.77%). ②At 7th day after VPA withdrawal and after 6 months of LTG monotherapy, BMI \[(20.97±1.2) kg/m2, (20.03±0.29) kg/m2\] and HOMA-IR \[(1.22±0.36), (1.01±0.11)\] of all patients were decreased, and there were significant differences at different time points (P<0.05). ③Before LTG monotherapy, LTG blood concentration was higher than that at 7 day of VPA withdrawal (P<0.05), and there was no significant difference in LTG blood concentration between at 7 day of VPA withdrawal and after 6 months of LTG monotherapy (P>0.05); ④After 6 months of LTG monotherapy, there was no significant difference in LTG blood concentration between patients with and those without epilepsy attack (P>0.05). Conclusion: LTG monotherapy can reduce the recurrence rate in patients with newly diagnosed epilepsy completely controlled by low-doses LTG combined with VPA. The curative effect is stable. It can reduce insulin resistance, and safety is high, without causing changes of LTG blood concentration.