添加拉考沙胺、吡侖帕奈治療兒童局灶性癲癇的臨床療效及對血清S100β、NSE水平的影響

［摘 要］目的 探討添加拉考沙胺、吡侖帕奈治療兒童局灶性癲癇的臨床療效及對血清S-100β蛋白（S100β）、神經元特異性烯醇化酶（NSE）水平的影響。方法 選擇2019年12月至2022年12月唐山市婦幼保健院收治的122例初始單藥治療控制不佳的局灶性癲癇患兒為研究對象。采用隨機數字表法將患者分為拉考沙胺組（添加拉考沙胺治療）和吡侖帕奈組（添加吡侖帕奈治療），每組各61例。比較兩組療效，治療前后智商、認知功能、血清S100β、NSE水平及治療期間不良反應的差異。結果 兩組治療1個月、3個月、6個月治療應答率比較差異均無統計學意義（P＞0.05）；拉考沙胺組操作智商（PIQ）評分較治療前增高（Z=2.775，P＜0.05），且高于吡侖帕奈組（Z=2.432，P＜0.05）；拉考沙胺組短時記憶廣度評分較治療前增高（Z=2.849，P＜0.05），吡侖帕奈組治療后注意分配測驗、短時記憶廣度評分較治療前降低（Z值分別為2.522、2.475，P＜0.05），拉考沙胺組治療后注意分配測驗、短時記憶廣度評分高于吡侖帕奈組（Z值分別為3.065、4.035，P＜0.05）；兩組治療后血清S100β、NSE水平較治療前均降低（t值分別為14.575、14.096、10.747、10.841，P＜0.05），組間比較差異無統計學意義（P＞0.05）；吡侖帕奈組易怒不良反應發生率高于拉考沙胺組，差異有統計學意義（P＜0.05）。結論 添加拉考沙胺和吡侖帕奈治療兒童局灶性癲癇均可有效控制癲癇發作，降低血清S100β、NSE水平，對智力影響較小；吡侖帕奈對患兒認知功能和精神狀態有一定負面影響。

［關鍵詞］兒童；癲癇；拉考沙胺；吡侖帕奈；S-100β蛋白；神經元特異性烯醇化酶

Doi：10.3969/j.issn.1673-5293.2024.09.008

［中圖分類號］R179""" ［文獻標識碼］A

［文章編號］1673-5293（2024）09-0049-08

Clinical efficacies of lacoxamide and perampanel as add-on therapy for refractory focal epilepsy

in children and their influences on patients serum S100β and NSE levels

［Abstract］ Objective To investigate clinical efficacies of lacoxamide and perampanel as add-on therapy on refractory local epilepsy in children and their influences on serum S-100β protein （S100β） and neuron-specific enolase （NSE） levels. Methods A total of 122 children with refractory local 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：lacoxamide group （n=61，the children received lacoxamide 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 Pgt; 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 lacoxamide group were higher than those before treatment （Z=2.775，Plt;0.05），and the scores were also higher than those in the perampanel group （Z=2.432，Plt;0.05）.And the scores in short-term memory span of the children in the lacoxamide group after treatment were higher than those before treatment （Z=2.849，Plt;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 Plt;0.05）.After treatment，the scores in attention allocation test and short-term memory span of the children in the lacoxamide group were higher than those in the perampanel group （Z=3.065 and 4.035 respectively，both Plt;0.05）.After treatment，the serum S100β and NSE levels of the children in the two groups were higher than before treatment （in the lacoxamide group：t=14.575 and 14.096 respectively;in the perampanel group：t=10.747 and 10.841 respectively，all Plt;0.05），and there were no statistical significant differences between the two groups before and after treatment （all Pgt;0.05）.The incidence of irritability as an adverse reaction of the children in the perampanel group was higher than that in the lacoxamide group （Plt;0.05）. Conclusion In treatment of refractory local epilepsy in children，both lacoxamide 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.

［Key words］ children;epilepsy;lacosamide;perampanel;S-100β protein;neuron-specific enolase

癲癇是一組以癲癇發作為特征的慢性神經系統疾病，易導致跌倒、燒傷、溺水和交通事故，癲癇患兒易受到歧視，對心理健康產生負面影響［1］。……