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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。
Objective To optimize the treatment of Infantile spasms (IS) with high-dose prednisone combined with Topiramate (TPM). Methods Sixty hospitalized children with IS diagnostic criteria were collected from September 2012 to September 2013 in Jiangxi Provincial Children’s Hospital, and randomly divided into control group and trial group, with 30 cases each followed up for at least 6 months. All children underwent VEEG monitoring before treatment, 2 weeks after treatment and at the end of treatment; Gesell’s developmental test was performed before treatment and 6 months after treatment. Results In the first week after prednisone treatment, the control rates of spasm in the second and the end of treatment were 46.67% and 60.00% respectively, which were higher than those in the control group (31.25% and 37.50%, respectively), but the difference was not statistically significant (P> 0.05). At the same time, the rate of high misdiagnosis in trial group was 46.67% and 60.00% respectively, which was also higher than that in control group (25.00% and 37.50%, P <0.05). The incidence of adverse reactions in the test and control groups (83.33% vs.80.00%) and recurrence rate (39.14% vs.40.00%) were not statistically different between the two groups (P> 0.05). At 2 weeks of treatment and at the end of treatment, the control rates of spasms in both groups were significantly higher than those in groups of 2 months or more (P <0.05), both in experimental group and control group. Conclusions The treatment of experimental group is better than that of control group. Early diagnosis and early treatment can provide significant therapeutic effect, and have an important influence on the control of seizure and the relief of high degree of misdiagnosis.