Therapeutic Effect And Mechanism Of Benzodiazepines In The Treatment Of Children With Epilepsy

Objective: To investigate the efficacy,influencing factors and mechanism of clonazepam(CZP)and Nitrazepam(NZP)in the treatment of children with epilepsy,so as to provide pediatric neurologist with the choice of drugs to help children with epilepsy.Objectives and methods: Clinical information and laboratory examinations of 159 children with epilepsy who were treated with clonazepam or nitrazepam from January 2015 to February 2019 in the Children's Hospital of Chongqing Medical University were collected by outpatient and telephone.They were divided into the seizure group and the discharge group according to the situation after the previous treatment,The efficacy and adverse reactions of the adding treatment were analyzed,and the factors that may affect the efficacy were analyzed by single factor analysis and multivariate analysis.The effects and possible mechanisms of CZP/NZP treatment were investigated from two aspects: seizure control rate and EEG discharge improvement rate.Results:1.Within 12 months after the addition of CZP/NZP,the overall seizure control rate was 63.5%(101/159)in all age groups,more than double the control rate of seizure in the previous treatment(30.2%(48/159),and the total effective rate was 91.2%(145/159).The overall EEG discharge control rate was 37.2%(45/121),which was more than 5 times higher than that of 5.8%(7/121),and the total EEG improvement rate was 64.5%(78/121).The seizure control rate in group A was 49.6%(55/111),and the EEG improvement rate in group B was 62.2%(71/114).2.The seizure control rate of CZP/NZP as the second additive was 65%,which was significantly higher than that of the additive treatment for refractory epilepsy,the third addition(control rate 40%)or the fourth addition(control rate 42.9%),and the difference is statistically significant.3.The highest frequency of CZP/NZP combination was VPA,LEV,OXC,and when VPA combined with CZP/NZP,The control rate of seizure was 86.8%,which was better than the control rate of LEV combined with CZP/NZP(61.9.%),the difference is significant(=4.896,P=0.027<0.05).4.The improvement rate of EEG increased with age,and in children aged 0-?3 years,>3-?7 years,and >7-?14 years old the improvement rate of EEG was 36.4%.61.7%,75.6%,which were significantly different by single factor analysis(=9.673,P=0.008)and multivariate analysis(0-3 years old,3-7 years old,P= 0.049,0.014)5.The improvement rate of EEG in patients with normal MRI was 76.2%,which was significantly higher than that in MRI abnormal group(47.2%).single factor analysis showed that the difference was significant(=4.566,P=0.033<0.05).6.In 40 patients with CZP/NZP treatment,the activity of ? was increased in the background of EEG.The control rate in these children was 65.4%,and the improvement rate was 65.8%.which were higher than those children without increased ? activity(The control rate was 44.7%,the improvement rate was 60.5%),but the difference between the two groups was not significant(P>0.05).7.The incidence of adverse reactions in this study was 23.9%.No serious adverse reactions occurred.There were fewer withdrawal symptoms at the time of drug withdrawal and fewer recurrences after drug withdrawal.The total recurrence rate after drug withdrawal was 8.1%.The EEG deterioration rate was 5.4%.Conclusion:In this study,the following conclusions were drawn from the observation,analysis of 159 children with epilepsy,and their seizure control rate,EEG improvement rate,its influencing factors and adverse reactions pre-and post-adding treatment with CZP/NZP:1.In the treatment of children with epilepsy,small doses of clonazepam or nitrazepam are effective and safe,and can achieve better results in seizure control and EEG improvement;2.Clonazepam or nitrazepam as an adding treatment in the control of seizures,as the second adding treatment is most effective,the more anti-epileptic drugs used in the early stage of treatment,the worse the efficacy,which may be related to the type of epilepsy and some refractory and drug resistance factors;3.Clonazepam or nitrazepam as an adding treatment in improving the EEG discharge of children,the better the improvement of EEG discharge in children with older onset,and it's possible that after adding treatment The background of the EEG has transient increased ? activities;4.Long-term treatment with small doses of clonazepam and nitrazepam for children with epilepsy has fewer adverse reactions and is well tolerated.Slow adding s and reductions can help reduce adverse reactions and withdrawal symptoms.