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目的探讨左乙拉西坦(LEV)对伴睡眠中癫性电持续状态(ESES)儿童癫的疗效。方法对14例癫儿童(男6例,女8例)在ESES时期给予LEV添加治疗(12例)或LEV单药治疗(2例),在治疗前后观察临床发作及视频脑电图(VEEG)情况,分析LEV在消除ESES现象、控制临床发作及改善认知方面的作用。结果起病年龄为1岁3个月～10岁。儿童良性癫伴中央颞区棘波(BECT)变异型10例,慢波睡眠期持续棘慢波综合征(CSWS)3例及Landau-Kleffner综合征(LKS)1例。LEV开始治疗年龄为3岁2个月～11岁3个月,随访时间为6～23个月。LEV对发作的疗效:显效1例,有效9例,无效4例,总有效率为71%,其中5例在随访3～6个月复发。LEV对VEEG的疗效:显效及有效各3例,无效8例,总有效率为42%,其中4例复发。激素治疗的总有效率和复发率分别为72%和50%。苯二氮类仅33%发作减少,SWI有短暂改善。LEV对BECT变异型的疗效优于对CSWS及LKS的疗效。结论 LEV在控制临床发作、消除ESES现象及改善认知方面有一定疗效。LEV疗效优于苯二氮类药物,与激素的疗效和复发率相当,但不良反应更少。
Objective To investigate the efficacy of levetiracetam (LEV) in the treatment of epileptic seizures in children with epileptic seizure (ESES). Methods Fourteen epileptic children (6 males and 8 females) were given LEV supplementation (12 cases) or LEV monotherapy (2 cases) during the ESES period. The clinical seizure and video-EEG (VEEG ), Analyzed the role of LEV in eliminating ESES phenomena, controlling clinical seizures and improving cognition. Results onset age of 1 year old 3 months to 10 years old. 10 cases of benign epilepsy with centrotemporal spike (BECT) variant, 3 cases of continuous spy-wave syndrome (CSWS) in slow wave sleep and 1 case of Landau-Kleffner syndrome (LKS). LEV began treatment for the age of 3 years and 2 months to 11 years of 3 months, followed up for 6 to 23 months. The curative effect of LEV on the attack was 1 case markedly effective, 9 effective cases and 4 ineffective cases, with a total effective rate of 71%, of which 5 cases were followed up for 3 to 6 months. Efficacy of LEV on VEEG: 3 cases were markedly effective and effective, 8 cases were ineffective and the total effective rate was 42%, of which 4 cases relapsed. The total effective rate of hormone therapy and recurrence rates were 72% and 50%. Only 33% of benzodiazepines decreased seizures, and SWIs improved briefly. The efficacy of LEV on BECT variants is superior to that of CSWS and LKS. Conclusion LEV has some curative effect in controlling clinical seizure, eliminating ESES phenomenon and improving cognition. LEV is superior to benzodiazepines in efficacy and hormone response and relapse rate, but with fewer adverse reactions.