Comparison Of Therapeutic Effects Of Different Therapeutic Regimens After Failure Of Single Drug Therapy In Children With Epilepsy And Analysis Of The Factors Affecting The Curative Effect Of Combined Use Of Drugs

Objective:To observe the curative effect of three different therapeutic schemes after the failure of monotherapy of antiepileptic drugs,to observe the factors affecting the curative effect of combined therapy,and to analyze the adverse reactions caused by the combination of drugs.Methods:In this study,epilepsy was diagnosed in the outpatient department of cangzhou central hospital from October 2016 to March 2018,and patients with epilepsy who were treated with a single drug after reaching the maximum treatment dose were taken as the research objects.We conducted an open,retrospective,controlled trial after the failure of monotherapy in epileptic children who were treated with Antiepileptic drugs(AED)but had never received any AED treatment.The enrolled patients were divided into three groups: group A,i.e.,the dose increase group,which adopted the current AED dose increase.Group B,the replacement monotherapy group,discontinued the first drug and switched to the second AED.Group C,the combination therapy group,was treated with the second AED combined with the first drug.The number of children without seizures in three groups was observed after 12 months of follow-up.To call into the group of patients on a regular basis or outpatient follow-up,patients with our request every 3 months to review the biochemical all items(liver and kidney function,myocardial enzyme,electrolyte,etc.),blood routine,five items of epilepsy(blood lactic acid,blood ammonia,pyruvic acid,homocysteine,beta-hydroxybutyric acid),drug blood drug concentration,semi-annual review eeg,to telephone follow-up of patients who were not timely review,until to exit the assigned treatment or follow-up of 12 months.Results:1.Comparison of general data among three groups of children with epilepsy,there was no significant difference among the three groups(P> 0.05).2.Increased dose group compared with the monotherapy group,there was no significant difference between the two groups(P>0.05).3.Increased dose group compared with the combination therapy group,there was a statistical difference between the two groups(P<0.05).Alternative monotherapy group compared with the combination therapy group,there was a statistical difference between the two groups(P<0.05).The efficacy of the combination therapy group was higher than that of the increased dose group and the single drug replacement group.4.In the analysis of the influence of gender,age,course of disease and duration of onset on the efficacy of combined medication,there was no significant difference(P>0.05).5.There were statistical differences in the number of seizure types,the continuous discharge of electroencephalogram(EEG),the positive results of MRI or CT,the frequency of seizures before treatment,the number of seizure types and the continuous discharge of EEG,and there was a significant difference between the two groups in the analysis of the effect of combination therapy before treatment(P<0.05).The results of MRI or CT were positive,and the frequency of seizure before treatment had a certain effect on the curative effect of combined therapy.6.All the patients in the treatment group were examined by CT or MRI,and 18 children with abnormal imaging were enrolled in the study.7.The incidence of adverse reactions in the increased dose group was higher than that in the replacement monotherapy group,there was no statistical difference between the two groups(P>0.05).The incidence of adverse reactions in the increased dose group was significantly higher than that in the combined treatment group,there was no statistical difference between the two groups(P>0.05).In comparison to that incidence of adverse reaction in the combination of the single-agent and the combination-use treatment group,there was no statistical difference between the two groups(P>0.05).Conclusion:By comparing the curative effect of different therapeutic schemes after the failure of single anti-epileptic drug treatment,the curative effect of combined therapy group is better.The number of epileptic seizure types,total number of epileptic seizures before treatment,continuous discharge of eeg,and positive MRI or CT results were the factors influencing the curative effect of combined therapy.The combination did not increase the incidence of adverse reactions.