| Objective: To study the correlation between the plasma concentration of levetiracetam and the efficacy of patients with epilepsy,to explore the relationship between the plasma concentration and dose,to provide the optimal blood concentration range for Chinese children,and to study the influence of age and add-on therapy on plasma concentration.The plasma concentration provides guidance for early clinical medication,to help control seizures,and reduction of adverse reactions.Methods: Inpatients and outpatients with epilepsy who were treated in the epilepsy clinic of Jiamusi Central Hospital from November 2017 to February 2019 were collected.50 patients with epilepsy treated with levetiracetam were enrolled.There were 28 males and 20 females,with an average age of 8.67±3.96 years and body weight 38.92±17.80 kg.The collected patients were stored,mainly collecting the basic conditions of the patients,including name,age,gender,weight,and contact information,and collecting the used medication,dose,frequency of attack,adverse reactions and EEG.Determination of levetiracetam plasma concentration in patients with epilepsy by solid phase extraction-high performance liquid chromatography(SPE-HPLC).Patients who met the criteria were selected for plasma concentration monitoring for 1 month,3 months,and 6 months,the seizure frequency and adverse reactions were regularly followed up.To observe whether there was a correlation between the plasma concentration and the efficacy;to explore the relationship between plasma concentration and dose,and to investigate the influence of age and add-on therapy on plasma concentration;and the influence of levetiracetam on EEG;the efficacy of levetiracetam monotherapy and add-on therapy.The data of 1 month,3 months and 6 months after treatment were analyzed by SPSS22.0 statistical software,and the experimental results were obtained.Results: of which the efficacy was 89.3% in the effective plasma concentration range 12 ?g/ml-46 ?g/ml,40% and 73% in the plasma concentration less than 8 ?g/ml and 8 ?g/ml-12 ?g/ml.The efficacy of effective blood concentration group 12 ?g/ml-46 ?g/ml and 8 ?g/ml-12 ?g/ml group was better than the low-blood concentration group(<8 ?g/ml)(p<0.05);there is no statistical difference between the efficacy of plasma concentration 12 ?g/ml-46 ?g/ml and 8 ?g/ml-12 ?g/ml.(p>0.05);the younger age group(2-9 years old)plasma concentration value was lower than the older age group(10-18 years old)(p<0.05);the plasma concentration of LEV combined with extended-release valproate tablets was different from that of monotherapy(p<0.05).The plasma concentration was positively correlated with the dose,the equation was Y=0.26X+2.62(R=0.449,p<0.001);there was significant difference between the effective group and ineffect group of 1 month and 3 month.(p<0.05).The analysis of plasma concentration values of 1 month and 3 months using box plot showed that the effective plasma concentration range was concentrated between 8 ?g/ml-15 ?g/ml;the correlation between plasma concentration and the rate of seizure reduction was analyzed,the plasma concentration value of 1 month was correlated with the rate of seizure reduction,and the equation Y=5.80X-3.77(R=0.571,p<0.001),the plasma concentration value of 3 months was related to the rate of seizure reduction,and the equation Y=1.89X+36.38(R=0.398,p=0.026).Levetiracetam monotherapy to treat focal seizure effective rate was 68.4%,to treat generalized seizure efficiency was 72.7%,adjuctive to treat focal seizure was 60%,to treat generalized seizure was 83%,there was no significant difference in the efficacy of levetiracetam monotherapy and combination therapy for different types of epilepsy(p>0.05);there was no significant difference in the effect of LEV monotherapy and combination therapy on EEG(p>0.05),all of them improve the discharge.The incidence of adverse reactions to levetiracetam was 14%,and the overall response was mild.Conclusion: The efficacy of levetiracetam was great when the plasma concentration was high,there was a positive correlation between the plasma concentration of 1 month and 3 months and the rate of seizure reduction;the plasma concentration of the younger age group(2-9 years old)was lower than that of the older age group(10-17 years old);the plasma concentration of LEV combined with extended-release valproate tablets was higher than that of monotherapy;and the plasma concentration of levetiracetam was positively correlated with the dose;the effective plasma concentration range was concentrated in 8 ?g/ml-15 ?g/ml. |
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