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目的观察拉莫三嗪(LTG)单药治疗新诊断儿童癫的疗效和安全性。方法选取2008年1月-2009年12月本院儿科神经门诊31例新诊断癫、使用LTG单药治疗的患儿。年龄6～16岁。将其中28例资料完整的患儿进行开放性自身对照研究。其中局限性发作24例(简单局限性发作18例,复杂局限性发作4例,局限继发全面性发作2例),全面强直-阵挛性发作4例。本组患儿均为首次诊断癫患儿,在此之前均未使用过任何抗癫药物;且患儿均为隐源性(或原发性)癫,经头颅CT或MRI、血生化、血常规等检查未发现其他系统疾病。LTG初始剂量为0.5 mg.kg-1.d-1,每周加量1次(0.5 mg.kg-1),4周增加至目标剂量4.0～5.0 mg.kg-1.d-1,平均剂量3.5 mg.kg-1.d-1。结果 31例患儿中3例失访,失访率9.68%。28例患儿随访时间均在6个月以上。总有效率为89.28%(25/28例),其中20例症状完全控制(71.43%,20/28例)。5例发作频率减少≥50%(17.86%,5/28例),2例症状控制不满意而加用第2种抗癫药物,1例(3.57%)因皮疹自行停药。不良反应为乏力(3/28例)、嗜睡(2/28例)、皮疹(1/28例);除1例出现皮疹停药外,其余患儿均未特殊处理,症状自然消失。结论 LTG单药治疗新诊断儿童癫疗效及安全性好,是单药治疗儿童新诊断癫的有效药物。
Objective To observe the efficacy and safety of lamotrigine (LTG) monotherapy in newly diagnosed childhood epilepsy. Methods From January 2008 to December 2009, 31 pediatric neurological outpatients with newly diagnosed epilepsy were treated with LTG monotherapy. Age 6 to 16 years old. 28 cases of complete data in children with open self-control study. Among them, 24 cases had a localized attack (18 cases of simple and limited attack, 4 cases of complicated and limited attack, and 2 cases of limited and complete attack) and 4 cases of generalized tonic-clonic seizure. This group of children are the first diagnosis of epilepsy in children, have not been used before any antiepileptic drugs; and children are cryptogenic (or primary) epilepsy, the skull CT or MRI, blood Biochemical, blood tests and other tests found no other systemic diseases. The initial dose of LTG was 0.5 mg.kg-1.d-1, once a week (0.5 mg.kg-1), and then increased to the target dose of 4.0-5.0 mg.kg-1.d-1 in 4 weeks mg.kg-1.d-1. Results 3 of 31 children were lost to follow-up and the rate of follow-up was 9.68%. 28 cases of children were followed up for more than 6 months. The total effective rate was 89.28% (25/28 cases), of which 20 cases were completely controlled (71.43%, 20/28). The frequency of seizures was reduced by 50% (17.86%, 5/28) in 5 patients. The second antiepileptic drug was not satisfied in 2 patients. One patient (3.57%) discontinued due to rash. Adverse reactions were fatigue (3/28 cases), drowsiness (2/28 cases), skin rash (1/28 cases). Except for one case of rash withdrawal, the rest of the children were treated with no special treatment and symptoms disappeared. Conclusion LTG monotherapy in children with new diagnosis of epilepsy efficacy and safety, monotherapy is a new drug for the diagnosis of epilepsy in children.