【摘要】 目的对大剂量泼尼松联合托吡酯(Topiramate,TPM)治疗婴儿痉挛症(Infantile spasms,IS)的治疗方案进行优化。方法收集2012年9月-2013年9月江西省儿童医院神经内科符合IS诊断标准的住院患儿60例,随机分为对照组和试验组各30例,至少随访6个月以上。所有患儿均于治疗前和治疗2周及疗程结束时进行视频脑电图(VEEG)监测;同时于治疗前和治疗6个月时进行Gesell发育测试。结果泼尼松治疗第1周无效的病例,在第2周和疗程结束时试验组的痉挛控制率分别是46.67%和60.00%,高于对照组的31.25%和37.50%,但差异无统计学意义(P>0.05);同时试验组的高度失律缓解率分别是46.67%和60.00%,也高于对照组的25.00%和37.50%,差异也无统计学意义(P>0.05)。试验和对照组不良反应的发生率(83.33%vs.80.00%),复发率(39.14%vs.40.00%),两组间比较无统计学差异(P>0.05)。在治疗2周及疗程结束时,无论试验组还是对照组,病程在2个月内的患儿痉挛控制率均明显高于病程2个月以上者(P<0.05)。结论试验组的治疗方案优于对照组,早期诊断、早期治疗可以显著提供疗效,对IS的发作控制和高度失律的缓解均具有重要影响。更多还原

【Abstract】 Objective To optimize the therapy protocols of high dose prednisone combined with topiramate( TPM) in children with infantile spasms( IS). Methods Sixty cases were collected in our hospital from September 2012 to September 2013 and randomly divided into two groups( n = 30) and followed-up for more than 6 months. The spasms were assesses by video-electroencephalogram( VEEG)monitoring including awake and asleep states before treatment,after two weeks of therapy and the end of the courses respectively. And the Gessel developmental quotient( DQ) scores were performed before treatment and after six months of therapy. Results For the unresponders to high dose prednisone in one week of therapy,there were 46. 67% and 60. 00% in test group higher than 31. 25% and 37. 50% in control group respectively in 2 week and in the end of treatment. And the rate of complete resolution of hypsarrhythmia in the test group was 46. 67% and 60. 00% higher than 25. 00% and 37. 50% in control group respectively in2 week and in the end of treatment. But there were no statistical significances between two groups( P >0. 05). The incidence of side effects( 83. 33% vs. 80. 00%) and the relapse rate( 39. 14% vs. 40. 00%),were not statistically significant between two groups( P > 0. 05). The responsive rates for the cases with the lead time within 2 months higher than beyond 2 months in two groups respectively in 2 weeks and in the end of treatment. Conclusions The protocol of the test group was superior to that of the control group. The responsive rates of children within 2 months of lead time were higher than beyond 2 months,which indicates that early diagnosis and early treatment would improve efficacy and have an important influence on the prognosis of IS.更多还原