| Objective(s):To explore and analyze the efficacy and safety of levetiracetam monotherapy for different seizure types of epilepsy,and the effect of levetiracetam monotherapy on EEG in children with epilepsy.Methods:From January 1,2016 to December 31,2018,there are 105 children who were diagnosed with epilepsy in the department of pediatrics of the first affiliated hospital of kunming medical university and returned to the hospital for review and follow-up in accordance with the rules prescribed by doctors for more than one year were initially treated with levetiracetam.These children with epilepsy are classified into focal epilepsy and generalized epilepsy according to the type of seizure.There were 50 children with focal epilepsy and 55 children with generalized epilepsy.On the basis of approximate conditions such as gender,age,course of onset and frequency of onset,50 cases(55 cases)of children diagnosed with focal epilepsy(generalized epilepsy)at the same time and initially treated with oxcarbazepine(valproate)were selected as the control group.All the selected children were returned to the hospital for re-examination at 3,6 and 12 months after medication according to the doctor's advice,and their seizures and adverse reactions were reported and recorded.4-hour video-electroencephalogram(VEEG)monitoring was performed before and 6 and 12 months after medication.At least 3 months after administration,patients with poor seizure control and the addition of another antiepileptic drug were not included in the observation group in the follow-up.The total effective rate was compared and analyzed between the levetiracetam group and the control group at 3 months after medication,and the complete control rate was compared and analyzed at 6 months and 12 months after medication.EEG changes were compared before and 6 and 12 months after administration.Results:In focal epilepsy,patients with initial monotherapy with levethiracetam,the total effective rate at 3,6 and 12 months after treatment was 74%,83.3%and 79.5%,respectively,and the complete control rate was 52%,59.5%and 56.4%,respectively.Patients with initial monotherapy with oxcarbazepine,the total effective rate at 3,6 and 12 months after treatment was 90%,95.8%and 100%,respectively,and the complete control rate was 78%,77.1%and 88.6%,respectively.There was no significant difference between the 3 months,6 months and 12 months after the treatment of levetiracetam(P>0.05).There was a statistically significant difference in the efficacy of levetiracetam and oxcarbazepine 3 months after treatment(P<0.05).And there was no significant difference in the complete control rate between the two groups after 6 months of treatment(P>0.05),there was a statistically significant difference in the complete control rate between the two groups at 12 months after administration(P<0.05).In generalized epilepsy,patients with initial monotherapy with levethiracetam,the total effective rate at 3,6 and 12 months after treatment was 80%,89.4%and 95.4%,respectively,and the complete control rate was61.8%,74.5%and 79.5%,respectively.Patients with initial monotherapy with valproate,the total effective rate at 3,6 and 12 months after treatment was85.4%,91.7%and 97.8%,respectively,and the complete control rate was 63.6%,79.2%and 88.9%,respectively.There was no significant difference between the 3 months,6 months and 12 months after the treatment of levetiracetam(P>0.05).There was no significant difference in the total effective rate at 3 months between the two groups after the treatment of levetiracetam and valproate(P>0.05).There was no significant difference in the complete control rate between the two groups at 6 months and 12 months after treatment(P>0.05).In the focal epilepsy,the EEG was improved after 6 months and 12 months of treatment,9.5%and 20.5%in the levetiracetam group and 16.7%and 29.5%in the oxcarbazepine group,respectively.There was no change in EEG,90.5%and 79.5%in the levetiracetam group and 83.3%and 70.5%in the oxcarbazepine group,respectively.In both groups,there was no case of EEG aggravation compared with the case of pre-existing epileptic discharge or background.There was no significant difference between the two groups(P>0.05).In the generalized epilepsy,the EEG was improved after 6 months and 12 months of treatment,27.8%and 39.4%in the levetiracetam group and 10.8%and 50%in the sodium valproate group,respectively.There was no change in EEG,and the levetiracetam group was 72.2%and 60.6%,respectively,and the valproate group was 89.2%and 50%,respectively.No EEG abnormal discharge aggravation was found in the two groups after medication.There were no cases of epileptic discharge due to medication.There was no significant difference between the two groups(P>0.05).Of the 105 children who received levetiracetam,1(0.9%)had behavioral changes and 4(3.8%)had mood changes and irritability,5(4.7%)cases the number of seizures increased in the first month after the first dose of medication,but the number of seizures after 1 month was significantly lower than before administration.No cases were withdrawn due to adverse reactions.Conclusion(s):The results of this study suggest that levetiracetam monotherapy for children with generalized epilepsy and focal epilepsy has good efficacy.In generalized epilepsy,levetiracetam is as effective as valproate.For focal epilepsy,oxcarbazepine is still the best choice because of its hypersensitivity reaction,levetiracetam is worthy of replacement drug recommend.Levetiracetam has a certain improvement effect on EEG,but there is no significant difference in improvement compared with valproate or oxcarbazepine.Levetiracetam monotherapy for children with generalized epilepsy and focal epilepsy has good efficacy and safety... |
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