The Study Of Lamotrigine Singly And Combined With Valproate Treating Epilepsy And Blood Concentration

BackgroundEpilesy is a common disease of the nervous system in various ages in our country. There are about50millions patients with epilepsy in the world, the rate of epilepsy is5-7%o and the incidence rate is50-100/100thousand/year. At present, the treatment of epilepsy is mainly rely on antiepileptic drugs, which is mainly single drug treatment and about60%new patients can be completely controlled, but one per three patients can’t be controlled, which not only damage their cognitivity and behavior but also bring a heavy load to patients and society. When patients fail to single drug treatment,6-30%epilepsy patients can be completely controlled by combined therepy. At present, LTG combined with VPA is the best choice for epilesy therepy, and studies finding that combining LTG with VPA ofen gets satisfactory effects. Some studies consider VPA inhibites metabolism of LTG and increases the blood concentration of LTG and thus improves the curative effect. But other studies also consider that the interaction of two durgs pharmacodynamics improves the curative effect.Methods:60patients with epilepsy in this study are all from department of the first affiliated hospital of Zhengzhou university from January,2011to October,2012, which concludes 34males and26females, ranging from2to68years old. These patients had used VPA for at least2months. The blood concentration and dosage are both within effective boundary, but seizure still can’t be controlled and happenned at least1time every month. This study takes8weeks to add drug and the details are as follows:For children,0.15mg/kg and one time every day for2weeks, once a day, then0.3mg/kg/d and two times every day for the next2weeks, and the maximum dose is1-5mg/kg/d. For adults, The initial dose is25mg once a day for two weeks, then25mg added every week, the maintenance dose is usually100-200mg/d divided2times to take, then39patient removed VPA after seizure was controlled by taking LTG and VPA for12weeks and keep only LTG for12weeks. Monitoring blood routine, liver function and the blood concentration of VPA in the beginning, the end of the eighth week, twentieth week, twenty-eighth week and fortieth week. Monitoring the blood concentration of VPA at the end of the eighth week, twentieth week, twenty-eighth week and fortieth week and observe clinical effects and side-effect. Statistic analyses were performed with SPSS17.0to analyse the curative effect of the combined phase of VPA and LTG and the phase of single LTG, to analyse the dose and blood concentration of single LTG, and to analyse the frequency of disease attack and side-effect and blood concentration.Result:1. In43patients with epilepsy, the rate of completely control is72%with the combination of LTG and VPA, and the effective rate is88%. The combination of LTG and VPA is better for tonic clonic seizure, but there is no significant difference compared with other types of seizures (P>0.05).11of39patients recur after stopping taking VPA, and the recurrent rate is24%, the effective rate is76%.2. With the combination of LTG and VPA,the blood concentration of LTG is9.65±3.85ug/ml,higher than LTGsingly(4.72±2.91ug/ml),so VPA could increase the blood concentration of LTG,and there is significantly statistical difference (P<0.01).3. When VPA combination with LTG, the average blood concentration of LTG is9.65ug/ml, and the effective rate of88%. When LTG singly, the average blood concentration of LTG is4.72ug/ml, and the efective rate of76%. So there is significantly statistical difference (P<0.05).4. In this study,21patients had side-effect.9patients had skin rash, and2patients stop-ped taking drugs because of skin rash. Others with side-effect disappear automatic-ally without special treatment.Conclusion:l.The curative effects of LTG combined with VPA are superior, not only VPA increasing the blood concentration of LTG, but also different mechanisms in pharmacodynamics, so the effect can be enhanced. This therapy has higher curative rate and it dosen’t increase the side-effect. At present, LTG combined with VPA for epilepsy is the most scientific and rational choice of drug combination, which is all effective to various seizures and is applied as board-spectrum antiepileptic drug in clinical practice.2. VPA inhibits the metabolism of LTG and prolongs the half-time, which increasing the lood concentration of LTG and further improving the curative effect.3. When the blood concentration of LTG at high levels, the curative effect is notable, suggesting there is correlation between clinical treatment effects and the blood concentration in most cases. So the drug concentration of LTG should be closely monitored, to control seizures effectively.4. LTG doesn’t significantly increase the side-effect of VPA, but we should pay attention to the happening of erythra. So we shoud add the dose according to the direction to reduce the incidence of erythra. On the whole, LTG has lesser side-effect, higher safety and be easy to tolerance.