난치성 부분간질에서 라모트리진(Lamotrigine)과 소디움 발프로에이트(Sodium Valproate) 병용요법에 의한 카바마제핀(Carbamazepine)의 치환
Substitution of Carbamazepine by Lamotrigine and Sodium Valproate Combination in Medically Refractory Partial Epilepsies
이병인, 김정연, 조정훈, 박동철,
소속 상세정보
이병인 ( Lee Byung-In )
연세대학교 의과대학 신경과학교실
김정연 ( Kim Jeong-Yeon )
연세대학교 의과대학 신경과학교실
조정훈 ( Cho Jeong-Hoon )
연세대학교 의과대학 신경과학교실
박동철 ( Park Dong-Chul )
연세대학교 의과대학 신경과학교실
KMID : 0877219980020010026
Abstract
Background: To evaluate the efficacy of lamotrigine (LTG) and sodium vaiproate (VPA) combination therapy in patients with partial epilepsies resistant to the maximally tolerable carbamazepine (CBZ) therapy
Methods: Patients with partial epilepsies taking maximlly tolerable dose of CBZ with or without other antiepileptic drugs (AEDS) should have one or more episodes of complex partial seizures or secondarily generalized tonic-clonic seizures (2°GTC) per every 4 week period during 12 weeks of baseline phase. LTG and VPA were introduced with gradual tapering off of CBZ over 12 to 16 weeks. Seizure frequencies measured during the 12 week period starting from the 5th week of complete withdrawal of CBZ were compared with that of the baseline phase.
Results: Complete substitution of CBZ by LTG and VPA in maximally tolerable doses was achieved in 32 of 35 patients included to the study. Mean number of seizures decreased from 6.0±10.7 episodes/4weeks to 2.2±3.5 episodes/4 weeks (p= 0.009). Complete freedom of seizures was achieved in 7 patients (21.9%). with the responder rate (> 50% seizure frequency reduction) of 65.6%. The first 4 weeks after complete withdrawal of CBZ were the most vulnerable period for the acute exacerbation of seizures or development of adverse experiences, which required a cereful clinical observation and dose adjustment.
Conclusion: Complete substitution of CBZ by LTG and VPA combination therapy was worthwhile to try in patients resistant to maximally tolerable CBZ therapy.
키워드
Carbamazepine;Lamotrigine;Sodium valproate;Pharmacodynamic interaction
원문 및 링크아웃 정보
등재저널 정보