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目的 观察妥泰快速增量法用于婴幼儿期频繁发作的癫癎治疗。方法 对43例年龄2个月17d～2岁的多种发作类型的婴幼儿期癫癎患儿,从1～2mg/(kg·d)起始,以每2～3d或3～7d快速增量,分别在1、2或3周达目标剂量或最大疗效,观察分析其疗效和不良反应。结果 均完成1～3周增量期。最大剂量2.2～10mg/(kg·d)[平均4.9±1.0mg/(kg·d)]。除3例治疗后4～8周中断外,观察时间均为3～9个月。1周后达最大剂量者19例(44.2％),2周或3周者分别17例(39.5％)或7例(16.3％)。26例为妥泰单药治疗。发作减少50％以上的总有效率为83.3％,其中51.2％发作完全控制。22/43例(51.2％)发生35人次不良反应,以食欲减退(9/22例)、嗜睡(7/12例)和体重减轻(6/22例)最常见,次为出汗减少和奖吵不安(各4/22例),汗少伴发热或轻泻(各2/22例),皮疹和睡眠减少(各1/22例)等。除1例因无汗伴发热和1例与卡马西平联用发生皮疹自行停药外,均继续用药,并在2～7周消失。结论 无论单药或联合用药,对频繁发作的婴儿期癫癎,采用快速增量法既不影响疗效,且安全可行。食欲减退和嗜睡是最常见的早期副作用。应根据病情需要和个体耐受力决定不同剂量和增量速度。考虑婴幼儿生理特性,应对快速加量者作更多临床和实验室监测。
Objective To observe the rapid increment method of Topotecan for the treatment of epilepsy with frequent seizures in infancy. Methods Forty-three infants with infantile epilepsy of 17-year-old and 2-year-old aged 2 months and with multiple exacerbations were treated with 1 ~ 2mg / (kg · d) Dose, respectively, at 1, 2 or 3 weeks target dose or maximum effect, observation and analysis of its efficacy and adverse reactions. The results were completed 1 to 3 weeks of increment. The maximum dose of 2.2 ~ 10mg / (kg · d) [average of 4.9 ± 1.0mg / (kg · d)]. Except 3 weeks after treatment interruption of 4 to 8 weeks, the observation time were 3 to 9 months. Nine patients (44.2%) reached the maximum dose after one week, 17 (39.5%) or 7 patients (16.3%) respectively at 2 weeks or 3 weeks. Twenty-six cases were topiramate monotherapy. The overall response rate for episodes decreased by more than 50% was 83.3%, with 51.2% of episodes completely controlled. A total of 35 adverse reactions occurred in 22/43 patients (51.2%), with the most frequent being appetite loss (9/22), drowsiness (7/12) and weight loss (6/22) Noisy (4/22 cases each), Khan with fever or laxity (2/22 cases each), Rash and sleep reduction (1/22 cases) and so on. Except for 1 case of non-sweating with fever and 1 case of carbamazepine in combination with rashes self-withdrawal, continue to medication, and disappear in 2 to 7 weeks. Conclusion Both single-drug and combination therapy, for rapid infantile epilepsy, the rapid increment method does not affect the efficacy, and safe and feasible. Loss of appetite and lethargy are the most common early side effects. Should be based on the needs of patients and individual tolerance to determine the different doses and incremental rate. Considering the physiological characteristics of infants and young children, more clinical and laboratory monitoring should be carried out on those who have rapid dosage.