The clinical effect of lamotrigine combined with high-dose diazepam in the treatment of benign epilepsy in children with central temporal spikes and epileptic electrical persistence during sleep
LU Lin, QU Rui, DAI Yuanyuan
Department of Pediatric Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
摘要目的: 评估拉莫三嗪联合大剂量地西泮治疗儿童良性癫痫伴中央颞区棘波(benign epilepsy with centrotemporal spikes,BECT)合并睡眠中癫痫性电持续状态(electrical status epilepticus during sleep,ESES)患儿的临床效果。方法: 选取2019年1月—2023年2月徐州医科大学附属医院收治的80例BECT合并ESES患儿的临床资料,按随机数字表法分为对照组(拉莫三嗪治疗)和观察组(拉莫三嗪联合大剂量地西泮治疗)各40例,均治疗3个月。比较两组临床疗效、癫痫发作频次及持续时间、放电指数、脑电活动情况、操作智商(PIQ)、语言智商(VIQ)、全量表智商(FIQ)评分及血清标志物水平及不良反应发生情况。结果: 观察组治疗总有效率高于对照组;观察组的癫痫发作频次少于对照组,持续时间短于对照组,痫样放电次数及累及导联数少于对照组,差异有统计学意义;治疗后,两组VIQ、PIQ和FIQ评分、脑电情况较治疗前升高,观察组PIQ、VIQ、FIQ、血清生物标志物水平高于对照组;差异有统计学意义;两组不良反应发生率比较无统计学意义。结论: 拉莫三嗪联合大剂量地西泮治疗BECT合并ESES患儿可提高疗效,且安全性较高。
Abstract:Objective To evaluate the clinical efficacy of lamotrigine combined with high-dose diazepam in the treatment of benign epilepsy in children with central temporal spike wave (BECT) and status epilepticus during sleep (ESES) . Methods Clinical data of 80 children with BECT combined with ESES admitted to Xuzhou Medical University Affiliated Hospital from January 2019 to February 2023 were selected. They were randomly divided into a control group (treated with lamotrigine) and an observation group (treated with lamotrigine combined with high-dose diazepam) using a random number table method, with 40 cases in each group. Both groups were treated for 3 months. Compare the clinical efficacy, frequency and duration of seizures, discharge index, EEG activity, PIQ, VIQ, FIQ scores, serum biomarker levels, and incidence of adverse reactions between two groups. Results The total effective rate of the observation group was higher than that of the control group; The frequency of epileptic seizures in the observation group was lower than that in the control group, and the duration was shorter than that in the control group. The number of epileptiform discharges and the number of involved leads were both lower than those in the control group, and the difference was statistically significant; The scores of VIQ, PIQ, and FIQ, as well as the EEG, improved in both groups compared to before treatment. The PIQ, PIQ, FIQ, and serum biomarker levels in the observation group were higher than those in the control group; The difference was statistically significant; There was no statistically significant difference in the incidence of adverse reactions between the two groups. Conclusion The combination of lamotrigine and high-dose diazepam can improve the efficacy and safety of BECT combined with ESES in children.
陆琳, 渠蕊, 戴园园. 拉莫三嗪联合大剂量地西泮治疗儿童良性癫痫伴中央颞区棘波合并睡眠中癫痫性电持续状态的临床效果[J]. 湖南师范大学学报(医学版), 2024, 21(4): 93-96.
LU Lin, QU Rui, DAI Yuanyuan. The clinical effect of lamotrigine combined with high-dose diazepam in the treatment of benign epilepsy in children with central temporal spikes and epileptic electrical persistence during sleep. HuNan ShiFan DaXue XueBao(YiXueBan), 2024, 21(4): 93-96.
[1] 肖波, 刘鼎. 浅谈癫痫的自身免疫机制[J]. 中华神经科杂志, 2024, 57(2): 101-107. [2] 牛杰朝, 张瑜, 王建东, 等. 儿童癫痫持续状态严重程度评分量表与PEDSS评分量表对癫痫持续状态患儿近期预后评估的应用价值[J]. 中华实用儿科临床杂志, 2024, 39(1): 54-58. [3] 李梦琳, 张新, 杨莉, 等. BRWD3基因变异相关婴儿癫痫性痉挛综合征临床表型及遗传学分析[J]. 中华神经科杂志, 2024, 57(2): 141-148. [4] ZHANG X, QIU S, YANG L, et al.[Clinical features and genetic analysis of five children with epilepsies due to variants of SCN8A gene][J]. Zhonghua yi xue yi chuan xue za zhi, 2024, 41(2): 174-180. [5] SINGH K P, AHMAD S T.Nrf2 as a potential target for the treatment of epilepsy[J]. Neural Regen Res, 2024, 19(9): 1865-1866. [6] KENZA B, IMAD B, EL I O, et al.Acute headache and seizures in psychiatric patient revealing atypical location of a ruptured dermoid cyst[J]. Radiol Case Rep, 2024, 19(3): 1040-1045. [7] OMAIR F, AKIFA A, MUHAMMAD A, et al.Lamotrigine-associated toxic epidermal necrolysis[J]. Pak J Med Sci, 2023, 39(6): 1883-1886. [8] HYUN E S, SEUNGGON K, JAEHON L, et al.Successful Early Lamotrigine and Aripiprazole Augmentation of Clomipramine in Severe Obsessive-compulsive Disorder[J]. Clin Psychopharmacol Neurosci, 2023, 21(3): 604-608. [9] 龚潘, 薛姣, 杨志仙, 等. 大剂量地西泮在伴睡眠中癫痫性电持续状态癫痫患儿中的应用[J]. 中华实用儿科临床杂志, 2018, 33(21): 1645-1648. [10] ANONYMOUS. Proposal for revised classification of epilepsies and epileptic syndromes[J]. Epilepsia, 1989, 30(4): 389-399. [11] 孙晴晴, 张亚男, 汤琪. 癫痫共病睡眠障碍治疗中国专家共识解读与评价[J]. 中风与神经疾病杂志, 2020, 37(11): 1039-1042. [12] 陈书远, 刘金宝, 刘世祺. 左乙拉西坦联合奥卡西平治疗儿童癫痫的疗效及对患者免疫功能、脑电图及认知功能的影响[J]. 海南医学, 2022, 33(7): 894-897. [13] 杨爱云. 左乙拉西坦联合奥卡西平治疗小儿癫痫的效果、 不良反应及脑电图改善情况研究[J]. 临床研究, 2020, 28(12): 66-67. [14] JING J, SUN H, KIM JA,et al.Development of Expert-Level Automated Detection of Epileptiform Discharges During Electroencephalogram Interpretation[J]. JAMA Neurol, 2020,77(1):103-108. [15] 周灵芝, 占婷婷, 钟春梅. 综合康复护理对脑瘫患儿智力发育及心理运动发育情况的影响分析[J]. 护士进修杂志, 2021, 36(7): 640-643. [16] 席艳丽, 王瑞珠, 徐化凤, 等. 3.0 T MR扩散张量成像对儿童急性淋巴细胞白血病化疗前后认知功能的评价[J]. 临床放射学杂志, 2021, 40(4): 783-789. [17] 刘银侠, 李红, 赵宁侠, 等. 口腔感知觉训练改善智力低下患儿语言障碍的临床研究[J]. 听力学及言语疾病杂志, 2021, 29(5): 491-495. [18] 王健, 刘灿, 李秋波. 儿童良性癫痫伴中央颞区棘波的演化机制研究进展[J]. 临床神经病学杂志, 2022, 35(3): 225-228. [19] ARNHEM V L M M, MUNCKHOF D V B, ARZIMANOGLOU A, et al. Corticosteroids versus clobazam for treatment of children with epileptic encephalopathy with spike-wave activation in sleep (RESCUE ESES): a multicentre randomised controlled trial[J]. The Lancet Neurology, 2024, 23(2): 147-156. [20] TRUESDALE N, KNOLES C, BROWN R.471 - Marijuana-induced seizures in a 4-month-old. A unique presentation requiring child protection team evaluation[J]. Am J Med Sci, 2024, 367(S1): S283-S284. [21] 张晓旭, 陈子怡, 任瑞娜, 等. 癫痫患者丙戊酸与拉莫三嗪药代动力学相互作用研究[J]. 中国临床药理学杂志, 2021, 37(1): 66-69. [22] 李海妮, 卞宏生, 张建霞, 等. 左旋四氢巴马汀和地西泮对条件性恐惧大鼠镇静及抗焦虑作用的比较[J]. 中华行为医学与脑科学杂志, 2021, 30(12): 1057-1063. [23] 袁海, 李杏, 黄诗琴, 等. 左乙拉西坦治疗儿童良性癫痫伴中央颞区棘波合并睡眠中癫痫性电持续状态的临床效果及对放电指数的影响[J]. 中国现代医学杂志, 2023, 33(7): 85-89. [24] BOSAK M, SŁOWIK A, IWAŃSKA A,et al. Co-medication and potential drug interactions among patients with epilepsy[J]. Seizure, 2019,66:47-52. [25] QURESHI I, RIAZ A, KHAN R,et al.Effects of Pregabalin, Nimodipine, and Their Combination in the Inhibition of Status Epilepticus and the Prevention of Death in Mice[J]. Turk J Pharm Sci, 2021,18(4):398-404. [26] 王甜, 粟胜勇, 张熙, 等. "心胆同治"麦粒灸对抑郁共病失眠大鼠海马单胺类神经递质水平的影响[J]. 世界科学技术-中医药现代化, 2023, 25(1): 235-242.