添加拉考沙胺、吡仑帕奈治疗儿童局灶性癫痫的临床疗效及对血清S100β、NSE水平的影响

Clinical efficacies of lacosamide and perampanel as add-on therapy for refractory focal epilepsy in children and their influences on patients' serum S100β and NSE levels

摘要

目的 探讨添加拉考沙胺、吡仑帕奈治疗儿童局灶性癫痫的临床疗效及对血清S100β蛋白(S100β)、神经元特异性烯醇化酶(NSE)水平的影响。方法 选择2019年12月至2022年12月唐山市妇幼保健院收治的122例初始单药治疗控制不佳的局灶性癫痫患儿为研究对象.采用随机数字表法将患者分为拉考沙胺组(添加拉考沙胺治疗)和吡仑帕奈组(添加吡仑帕奈治疗),每组各61例.比较两组疗效,治疗前后智商、认知功能、血清S100β、NSE水平及治疗期间不良反应的差异。结果 两组治疗1个月、3个月、6个月治疗应答率比较差异均无统计学意义(P＞0.05);拉考沙胺组操作智商(PIQ)评分较治疗前增高(Z＝2.775,P＜0.05),且高于吡仑帕奈组(Z＝2.432,P＜0.05);拉考沙胺组短时记忆广度评分较治疗前增高(Z＝2.849,P＜0.05),吡仑帕奈组治疗后注意分配测验、短时记忆广度评分较治疗前降低(Z值分别为2.522、2.475,P＜0.05),拉考沙胺组治疗后注意分配测验、短时记忆广度评分高于吡仑帕奈组(Z值分别为3.065、4.035,P＜0.05);两组治疗后血清S100β、NSE水平较治疗前均降低(t值分别为14.575、14.096、10.747、10.841,P＜0.05),组间比较差异无统计学意义(P＞0.05);吡仑帕奈组易怒不良反应发生率高于拉考沙胺组,差异有统计学意义(P＜0.05)。结论 添加拉考沙胺和吡仑帕奈治疗儿童局灶性癫痫均可有效控制癫痫发作,降低血清S100β、NSE水平,对智力影响较小;吡仑帕奈对患儿认知功能和精神状态有一定负面影响.

Abstract

Objective To investigate clinical efficacies of lacosamide and perampanel as add-on therapy on refractory focal epilepsy in children and their influences on serum S100β protein (S100β) and neuron-specific enolase (NSE) levels. Methods A total of 122 children with refractory focal epilepsy who admitted to our hospital and had poor therapeutic effects in initial single antiepileptic drug treatment from December 2019 to December 2022 were selected as study subjects. In random number table method, the children were divided into two groups: lacosamide group (n=61, the children received lacosamide add-on therapy) and perampanel group (n=61, the children received perampanel add-on therapy). The therapeutic effects, intelligence quotient (IQ), cognitive function (CF), serum S100β and NSE levels before and after treatment and adverse reactions during treatment were compared between the two groups. Results There were no significant differences in total response rates at 1 month, 3 months and 6 months of treatment between the two groups (all P＞0.05). After treatment, the scores in performance intelligence quotient (PIQ) in Chinese-Wechsler intelligence scale of children (C-WISC) of the children in the lacosamide group were higher than those before treatment (Z=2.775, P＜0.05), and the scores were also higher than those in the perampanel group (Z=2.432, P＜0.05). And the scores in short-term memory span of the children in the lacosamide group after treatment were higher than those before treatment (Z=2.849, P＜0.05). While in the perampanel group, after treatment, the scores in attention allocation test and short-term memory span of the children were lower than those before treatment (Z=2.522 and 2.475 respectively, both P＜0.05). After treatment, the scores in attention allocation test and short-term memory span of the children in the lacosamide group were higher than those in the perampanel group (Z=3.065 and 4.035 respectively, both P＜0.05). After treatment, the serum S100β and NSE levels of the children in the two groups were higher than before treatment (in the lacosamide group: t=14.575 and 14.096 respectively; in the perampanel group: t=10.747 and 10.841 respectively, all P＜0.05), and there were no statistical significant differences between the two groups before and after treatment (all P＞0.05). The incidence of irritability as an adverse reaction of the children in the perampanel group was higher than that in the lacosamide group (P＜0.05). Conclusion In treatment of refractory focal epilepsy in children, both lacosamide and perampanel can effectively control onset of seizures, reduce the serum levels of S100β and NSE of the children, and they exert few effects on intelligence of the children; in addition, perampanel has certain negative effects on cognitive function and mental state of the children.

关键词

儿童 / 癫痫 / 拉考沙胺 / 吡仑帕奈 / S100β蛋白 / 神经元特异性烯醇化酶

Key words

children / epilepsy / lacosamide / perampanel / S100β protein / neuron-specific enolase

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基金资助

河北省医学科学研究课题(20221747)