Acta Neurol Scand:拉考沙胺可有效且安全的治疗脑血管病因的癫痫患者

2021-05-12 MedSci原创 MedSci原创

脑血管疾病,特别是脑卒中,是老年人新发癫痫的最常见原因之一。拉考沙胺是一种非酶诱导的抗癫痫药物,适用于4岁及以上患者局灶性癫痫的单药和辅助治疗。临床前研究表明拉考沙胺有神经保护作用。一项小规模试点研究

血管疾病,特别是脑卒中,是老年人新发癫痫的最常见原因之一。拉考沙胺是一种非酶诱导的抗癫痫药物,适用于4岁及以上患者局灶性癫痫的单药和辅助治疗。临床前研究表明拉考沙胺有神经保护作用。一项小规模试点研究(n = 16)表明,静脉注射拉考沙胺作为老年患者卒中后非惊厥性癫痫的初始治疗,具有良好的耐受性和疗效特征。但是,很少有研究评估AEDs对卒中后癫痫的耐受性和疗效,本项探索性的事后分析旨在评估口服拉考沙胺在脑血管病因癫痫(CVEE)成人中的耐受性和疗效,研究结果已发表于Acta Neurol Scand。

研究对拉考沙胺VS.卡马西平控释的双盲、初始单药治疗试验;双盲转换为拉考沙胺单药治疗试验;以及在一种抗癫痫药物中辅助应用拉考沙胺的观察研究进行探索性事后分析。根据基线时记录的癫痫病因,确定CVEE患者。

 

结果显示,在最初的单药治疗试验中,61名患者患有CVEE(拉考沙胺:27;卡马西平-CR:34)。20名(74.1%)服用拉考沙胺的患者(27名[79.4%]服用卡马西平-CR)报告了治疗突发的不良事件(TEAEs),最常见的是(≥10%)头痛、头晕和疲劳(卡马西平-CR:头痛、头晕)。与卡马西平-CR相比,服用拉考沙胺的患者完成6个月(22[81.5%];20[58.8%])和12个月(18[66.7%];17[50.0%])的治疗,且在最后评估的剂量中没有发作的患者比例更高。

 

在转为单药治疗的试验中,26/30(86.7%)名CVEE患者报告了TEAEs,最常见的是(≥4名患者)眩晕、抽搐、疲劳、头痛、嗜睡和认知障碍。在拉考沙胺单药治疗期间,17名(56.7%)患者的缓解率为50%,6名(20.0%)无癫痫发作。

 

在观察性研究中,36/83(43.4%)名CVEE患者报告了TEAEs,最常见的是(≥5%)疲劳和眩晕。对75名患者进行了疗效评估。在过去的3个月中,60名(80%)患者有50%的反应,42名(56.0%)患者无癫痫发作。

综上所述,此项探索性的事后分析表明,拉考沙胺在CVEE患者中具有良好的耐受性和有效性,最初的单药治疗试验的数据表明其疗效优于卡马西平-CR。

 

原始出处:

 

Felix Rosenow, et al., Lacosamide in patients with epilepsy of cerebrovascular etiology. Acta Neurol Scand. 2020 Jun;141(6):473-482. doi: 10.1111/ane.13230.  

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    2021-12-20 windight
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