摘要
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 Explore the efficiency of infantile epilepsy with topiramate (TPM) by quick titration. Methods Fourty three patients aged 2 months and 17 days to 2 years who suffered from many kinds infantile epilepsyi were observed. The dosage was started at the dosage of 1-2 mg/( kg·d), then titrated the dosage every 2-3 days or 3-7 days to the best response in 1,2 or 3 weeks. Results Titration peroid of 1-3 weeks were successfully finished in all patients. Final dosages were reached at the range of 2. 2 10 mg/(kg·d) [mean 4.9 ± 1.0 mg(kg·d) ]. The observed period of all patients were 3-9 months but only 4-8 weeks in 3 patients. Of them, maximal dosages were reached at the first week in 19 patients(44.2 % ), at the second week in 17 case (39.5 % ) and at the third week in 7 case( 16.3 % ) respectively. TPM were used as monotherapy in 26 patients with ±50 % seizure reduction of 83.3 % patients , and seizure free of 51.2 % patients. 51.2 % patients(22/43)appeared side effects, especially anorexia(9/22),lethargy(7/ 22)and weight losing(6/22). Among them, TPM were withdrew in two cases due to adiaphoresis with fever and tetters but combined use with Carbamazepin. All of the side effects disappeared during 2-7 weeks although continued TPM therapy. Conclusions Quick dosage titration of TPM would be efficient and safe for seizure controll in infants with frequent seizures. Anorexia and lethargy are early common side effect. The final dosage and different titrated steps must be carefully considered according to seizure frequency and individual tolerance. Close clinical observation and laboratory investigations could be more important because of their physiological characteristics in infantile period.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2003年第1期48-50,共3页
Journal of Applied Clinical Pediatrics
