| 摘要: |
| 目的：探讨丙戊酸钠（VPA）单药治疗学龄期癫痫患儿的疗效及其对认知功能的影响。方法：选取2017年1月至2018年1月我院80例学龄期癫痫患儿，均行VPA单药治疗。根据疾病类型的不同，分为Lennox Gastaut综合征（L-G综合征）组5例，全面性发作组19例，部分性发作组33例，部分发作继发全面发作组23例。比较各组患儿临床疗效、不良反应及治疗前后韦氏儿童智力量表评分情况。结果：80例患儿均接受16周的VPA单药治疗，其中完全控制34例，治疗总有效率82.50%（66/80）。L-G综合征组、全面性发作组、部分性发作组、部分发作继发全面发作组总有效率分别为80.00%、84.21%、93.94%、65.22%。部分性发作组词汇、排图、常识、积木评分较治疗前明显降低（P<0.05），部分发作继发全面发作组拼物、类同、译码评分较治疗前明显降低（P<0.05）。L-G综合征组、全面性发作组治疗后操作智商较治疗前明显降低（P<0.05），治疗后语言智商和全量表智商评分与治疗前比较差异无统计学意义（P>0.05）；部分性发作组治疗后操作智商、语言智商和全量表智商评分较治疗前明显升高（P<0.05）；部分发作继发全面发作组治疗后操作智商、语言智商和全量表智商评分与治疗前比较差异无统计学意义（P>0.05）。Pearson相关性分析结果显示，病程及癫痫发作频率与治疗前后操作智商、语言智商、全量表智商评分呈显著负相关（P<0.01）；发病年龄与治疗前后操作智商、语言智商、全量表智商评分呈显著正相关（P<0.01）。加量治疗期间，不良反应发生率8.75%（7/80）；维持治疗期间，不良反应发生率11.25%（9/80）。结论：应用VPA单药治疗不同类型癫痫患儿均具有一定临床疗效，且不良反应较轻，但部分发作继发全面发作组患儿的治疗有效率相对较低，因此临床应根据癫痫类型的不同，为患者选用合适的治疗药物以提高临床疗效。 |
| 关键词: 癫痫 丙戊酸钠 学龄期 儿童 认知功能 |
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| Efficacy of Sodium Valproate Monotherapy in the Treatment of School-Age Children with Epilepsy and Its Effects on Cognitive Function |
| Jin Chao, Hao Licheng, Chen Na, Dai Xiuhua, Pang Baodong |
| (Tangshan Maternal and Child Health Care Hospital, Hebei Tangshan 063000, China) |
| Abstract: |
| Objective: To probe into the efficacy of sodium valproate (VPA) monotherapy in the treatment of school-age children with epilepsy and its effects on cognitive function. Methods: Totally 80 school-age children with epilepsy admitted into our hospital from Jan. 2017 to Jan. 2018 were extracted, and all patients received VPA monotherapy. According to different types of diseases, there were 5 cases in the Lennox Gastaut syndrome (L-G syndrome) group, 19 cases in the comprehensive seizure group, 33 cases in the partial seizure group, and 23 cases in the partial attack followed by secondary comprehensive seizure group. The clinical efficacy, adverse drug reactions, and the Wechsler Intelligence Scale for Children (WISC) before and after treatment were compared. Results: Eighty patients received 16 weeks of VPA monotherapy, of which 34 cases were completely controlled, and the total effective rate was 82.50% (66/80). The total effective rate of the L-G syndrome group, the comprehensive seizure group, the partial seizure group and the partial attack followed by secondary comprehensive seizure group was respectively 80.00%, 84.21%, 93.94% and 65.22%. The scores of vocabulary, picture concepts, comprehension and block design in the partial seizure group were significantly lower than those before treatment (P<0.05), and the scores of matrix reasoning, similarities and coding in the partial attack followed by secondary comprehensive seizure were significantly lower than those before treatment (P<0.05). After treatment, the operational intelligence quotient (IQ) of the L-G syndrome group and the comprehensive seizure group was significantly lower than that before treatment (P<0.05), and there was no statistically significant difference in the scores of verbal IQ and full scale IQ before and after treatment (P>0.05). After treatment, the scores of operational IQ, verbal IQ and full scale IQ in the partial seizure group were significantly higher than those before treatment (P<0.05). There was no statistically significant difference in the scores of operational IQ, verbal IQ and full scale IQ in the partial attack followed by secondary comprehensive seizure group before and after treatment (P>0.05). Pearson correlation analysis showed that the course of disease and seizure frequency were significantly negatively correlated with the operational IQ, verbal IQ and full scale IQ before and after treatment (P<0.01). The age of onset was significantly positively correlated with the operational IQ, verbal IQ and full scale IQ before and after treatment (P<0.01). During the treatment period, the incidence of adverse drug reactions was 8.75% (7/80); during the maintenance treatment period, the incidence of adverse drug reactions was 11.25% (9/80). Conclusion: Different types of epilepsy children treated with VPA alone have a certain clinical efficacy, and the adverse drug reactions are mild, yet the treatment of children with partial seizures and secondary seizures is relatively ineffective. Therefore, according to different types of epilepsy, appropriate treatment drugs should be selected for children to better improve the clinical efficacy and obtain better treatment results. |
| Key words: epilepsy sodium valproate school-age children cognitive function |
