The Efficacy Analysis Of Antiepileptic Drugs Such As Topiramate In The Treatment Of Tic Disorder With Subclinical Epileptiform Discharge

Objective:To compare the improvement of electroencephalography and the improvement of tics in children with tic disorder and subclinical epileptiform discharge treated with different antiepileptic drugs,and to provide reference for the treatment of tic disorder with subclinical epileptiform discharge.Methods:We collect 121 children and adolescents diagnosed with tic disorder and subclinical epileptiform discharge from Children's Hospital of Chongqing Medical University,from January 2015-December 2018,who meet the inclusion criteria.They are divided into three groups according to different treatment methods:1.Topiramate treatment group(topiramate+/-sulpiride/haloperidol,group A),a total of 58 cases.2.Other anti-epileptic drug treatment group(LEV/VPA+/-sulpiride/haloperidol,group B),a total of 17 cases.3.No antiepileptic drug treatment group(sulpiride/haloperidol,group C),a total of 46 cases.We collect clinical data and laboratory test results(focus on EEG),and then follow up every 3 months by outpatient and/or telephone,and check blood concentration(VPA),liver and kidney function and EEG every six months.Retrospectively analyze the improvement of EEG after drug treatment in each group,the improvement of tics symptoms and the occurrence of adverse reactions.Results:1.Analysis of the improvement of EEG and the improvement of tic symptoms of in children in group A,B and C:(1)The EEG improvement rate of of groups A,B,and C after treatment are 63.8%,52.9%,and 39.1%,suggesting that children with antiepileptic drugs(groups A and B)have more obvious improvement rate of EEG,and improvement rates of EEG of children with no antiepileptic drugs(group C)is not obvious.However,the remission rate of tic symptoms in groups A,B,and C are 70.7%,82.4%,and 89.1%,suggesting that antiepileptic drugs with or without sulpiride or haloperidol have good effects on alleviating the clinical symptoms of children.(2)There is a significant difference in the improvement rate of EEG between groups A,B and C(?~2=6.263,P<0.05),especially the difference in EEG improvement rate between group A and group C is the most significant(?~2=6.262,P<0.05),and the improvement rates of EEG in group A and group B,group B and group C are different,but there is no significant difference(?~2=0.653 and 0.976,both P>0.05).2.Analysis of the EEG improvement in different treatment periods of children in group A,B and C:(1)There is a significant difference in the improvement rate of EEG between the three groups when treated in 6months(?~2=10.859,P<0.05).(2)There is no significant difference in the improvement rate of EEG between the three groups when treated in between 6 and 12 months and over 12 months(?~2=1.176 and 3.789,both P>0.05).(3)When treated in 6 months,multiple comparisons between multiple sample rates showed that there is a significant difference in the improvement rate of EEG between group A and group C(?~2=9.726,P<0.05),and the improvement rates of EEG in group A and group B,group B and group C are different,but there is no significant difference(?~2=0.175and 2.922,both P>0.05).3.Analysis of the EEG improvement of children in each group of A,B,and C during different treatment periods(?6months,>6-?12 months,>12 months):(1)Group A:there is no significant difference in EEG improvement rate between different treatment periods(?~2=5.377,P>0.05);(2)There is no significant difference in EEG improvement rates between different treatment periods in both Group B and group C(?~2=2.091 and 4.477,both P>0.05).4.Analysis of the EEG improvement in different age groups(preschool group and school age group)of children in each group of A,B and C:(1)Group A:There is no significant difference in the EEG improvement rate in different age groups(?~2=0.192,P>0.05);(2)Group B and Group C:There is also no significant difference in the improvement rate of EEG in different age groups(?~2=0.562 and 0.712,both P>0.05).(3)There is no significant difference in EEG improvement rate between group A,B and C in preschool age(?~2=0.469,P>0.05).However there is a significant difference in the EEG improvement rate between A,B,and C groups of school age(?~2=6.487,P<0.05).(4)There is a significant difference in the improvement rate of EEG between group A and group C in school-age(?~2=6.053,P<0.05).There is no significant difference in the improvement rate of EEG between group A and group B,group B and group C in the school-age(?~2=1.871 and 0.283,both P>0.05).5.Analysis of the recurrence of tics in children with A,B and C:(1)The recurrence rates of tic symptoms after treatment in each group of A,B,and C are 62.1%,52.9%,and 89.1%.There is a significant difference in the recurrence rate of tics between the three groups(?~2=12.302,P<0.05).(2)There is a significant difference in the recurrence rate of tic symptoms between group A and group C,group B and group C(?~2=9.774 and 9.926,both P<0.05).There is no significant difference in the recurrence rate of tic symptoms between group A and group B(?~2=0.456,P>0.05).It shows that the improvement effect of the tic symptoms in group A and group B is more stable,and the recurrence rate of group A and B are lower than group C.6.This article summarizes the characteristics of 5 children with tic disorder combined with subclinical epileptiform discharge and ADHD.All 5 cases are treated with antiepileptic drugs,and 4 cases are treated with sulpiride.The EEG improvement rate is 75%(3/4),and the tics of the 5 patients significantly improve within 3-6 months.7.A total of 19 adverse reactions occurred in the three groups of children,the incidence rate was 15.7%.And the adverse reactions are mainly weight gain,lethargy,gastrointestinal symptoms,decreased sweating,etc.In the end,they gradually reduce or disappeare,and there is no case of stopping the drug because of the inability to tolerate adverse reactions.Conclusion:1.Using any one anti-epileptic drug between TPM,LEV and VPA,regardless of whether or not adding sulpiride/haloperidol,the tic symptoms and EEG of the children are better controlled than before.2.Whether using TPM or LEV/VPA,it has a good effect on improving the tic symptoms and EEG in children,they not only have the similar effects,but also have no differences in effects between different age groups and different gender.It is indicated that children with tic disorder with subclinical epileptiform discharge can use one of the above three antiepileptic drugs to control their tic symptoms and improve their abnormal EEG;However,during the three drugs,TPM improve the EEG more obviously,especially for patient who are in school-age or treated within six months.There is a significant difference in EEG improvement rates between children with TPM and those without AEDs.3.When used anti-tic drugs alone in the treatment of tic disorder with subclinical epileptiform discharge,tics are prone to recurrence.The efficacy is more stable combining with anti-epileptic drugs(TPM/LEV/VPA).4.Antiepileptic drugs have good effect on EEG and tic symptoms in children with tic disorder combined with subclinical epileptiform discharge and ADHD.The ADHD has no significant effect on the treatment of tic disorder with subclinical epileptiform discharge.5.The adverse reactions of TPM,LEV and VPA were mild.When they are used to treat tic disorder and subclinical epileptiform discharge,and the majority adverse reactions disappear or can be tolerated with the prolongation of medication time.