Neurology：服用丙戊酸钠或可降低顶叶厚度及全脑体积

服用丙戊酸钠明显降低顶叶皮层厚度

丙戊酸钠是常用的广谱抗癫痫药物，但该药对脑的影像尚不明确。来自澳大利亚的Heath R等医生研究了丙戊酸钠对脑的影响，发表在2013年5月14日的Neurology上。该研究假设癫痫患者的全脑体积、脑白质容积及脑叶皮层厚度可能会有不同，从而在服用丙戊酸钠和非丙戊酸钠的癫痫患者及健康对照人群中对比这些指标。研究发现：服用丙戊酸钠的癫痫患者顶叶厚度、全脑体积及脑白质容积减少。

研究的患者人群初始数据来源于三级癫痫医疗中心的局灶性难治性癫痫患者，随后在来源于儿童期发病癫痫社区研究中选择另一组相互独立患者影像资料进行验证性研究。采用FreeSurfer 5.1软件分析全脑MRI的T1加权像，分别测量全脑体积、脑白质容积，额叶、顶叶、枕叶及颞叶的厚度。

服用丙戊酸钠的癫痫患者的顶叶厚度减少，全脑体积及脑白质容积减少。

证据等级：这项研究提供了一项IV级证据，即：服用丙戊酸钠的癫痫患者顶叶厚度、全脑体积及脑白质容积减少。

Sodium valproate use is associated with reduced parietal lobe thickness and brain volume.
OBJECTIVE
We hypothesized that total brain volume, white matter volume, and lobar cortical thickness would be different in epilepsy patients. We studied valproate relative to nonvalproate by using patients with epilepsy and healthy controls.
METHODS
Patients with focal intractable epilepsy from a tertiary epilepsy center were the primary group for analysis. A confirmatory analysis was carried out in an independent group of subjects imaged as part of a community-based study of childhood-onset epilepsy. Total brain volume; white matter volume; and frontal, parietal, occipital, and temporal lobe thickness were measured by processing whole-brain T1-weighted MRI using FreeSurfer 5.1.
RESULTS
Total brain volume, white matter volume, and parietal thickness were reduced in the valproate group relative to controls and nonvalproate users (valproate, n = 9; nonvalproate, n = 27; controls, n = 45; all male). These findings were confirmed in an independent group (valproate, n = 7; nonvalproate, n = 70; controls, n = 20; all male).
CONCLUSIONS
Sodium valproate use in epilepsy is associated with parietal lobe thinning, reduced total brain volume, and reduced white matter volume.
LEVEL OF EVIDENCE
This study provides Class IV evidence that use of valproate in epilepsy is associated with reduced parietal lobe thickness, total brain volume, and white matter volume.