目的 探討不同劑量拉莫三嗪治療老年癲癇患者的臨床療效。方法 選擇2014年7月—2018年2月洛陽(yáng)市第三人民醫(yī)院神經(jīng)內(nèi)科診治的老年癲癇患者88例作為研究對(duì)象，根據(jù)拉莫三嗪使用劑量分為對(duì)照組（40例）和觀察組（48例）。對(duì)照組患者給予大劑量拉莫三嗪片治療，拉莫三嗪起始劑量25 mg/d，2周后為50 mg/d，第5周以后為目標(biāo)劑量100 mg/d，維持100 mg/d治療觀察至第8周。觀察組患者給予小劑量拉莫三嗪片治療，起始劑量25 mg/d，2周后為50 mg/d，第5周以后為目標(biāo)劑量50 mg/d，維持50 mg/d治療觀察至第8周。觀察兩組患者的臨床療效，同時(shí)比較兩組患者蒙特利爾認(rèn)知評(píng)估量表（MoCA）評(píng)分、P300潛伏期、波幅和不良反應(yīng)情況。結(jié)果 治療后，對(duì)照組和觀察組總有效率分別為97.5%、97.9%，兩組對(duì)比差異無(wú)統(tǒng)計(jì)學(xué)意義。治療后，兩組患者的MoCA評(píng)分均顯著高于治療前，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；且觀察組治療后的MoCA評(píng)分顯著高于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，觀察組的P300潛伏期顯著降低，波幅明顯升高，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；且觀察組治療后P300潛伏期及波幅顯著優(yōu)于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀察組治療期間的不良反應(yīng)發(fā)生率為6.3%，顯著低于對(duì)照組的32.5%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 相對(duì)于大劑量，小劑量拉莫三嗪治療老年癲癇患者能達(dá)到很好的療效，能減少不良反應(yīng)的發(fā)生，改善患者的神經(jīng)電生理功能與認(rèn)知功能。

Objective To investigate the clinical effects of different doses of lamotrigine in treatment of elderly epilepsy. Methods Elderly patients (88 cases) with epilepsy in Luoyang Third People's Hospital from July 2014 to February 2018 were divided into control group (40 cases) and observation group (48 cases) accorded to the dose of lamotrigine. Patients in the control group were given large doses of Lamotrigine Tablets, starting at 25 mg/d, followed by 50 mg/d 2 weeks later, followed by a target dose of 100 mg/d after 5 weeks, and maintained at 100 mg/d until 8 weeks. Patients in the observation group were given a small dose of Lamotrigine Tablets, starting at 25 mg/d, followed by 50 mg/d 2 weeks later, followed by 50 mg/d after 5 weeks, and maintained at 50 mg/d until 8 weeks. After treatment, the clinical efficacy in two groups were observed, and the MoCA score, P300 incubation period, amplitude, and adverse reactions were compared. Results After treatment, the total effective rates in the control group and the observation group were 97.5% and 97.9%, respectively, there was no significant difference between two groups. After treatment, the MoCA scores in two groups were significantly increased, the difference before and after treatment in the same group was statistically significant (P<0.05). And the MoCA score in the observation group was significantly higher than that in the control group, the difference between two groups was statistically significant (P<0.05). After treatment, P300 latency in the observation group was significantly decreased, but the amplitude was increased, the difference in the same group was statistically significant (P<0.05). And the P300 latency and amplitude in the observation group after treatment were significantly better than those in the control group, the difference between two groups was statistically significant (P<0.05). During the treatment, the incidence of adverse reactions was 6.3% in the observation group, which was significantly lower than 32.5% in the control group, the difference between two groups was statistically significant (P<0.05). Conclusion Compared with large dose, small dose of lamotrigine in treatment of elderly epilepsy patients can achieve a good effect, reduce the occurrence of adverse reactions, and improve the patients' neuroelectrophysiological function and cognitive function.

R971

河南省社會(huì)發(fā)展項(xiàng)目（0624410102）