摘要
目的 评价抗癫痫药物治疗难治性局灶性癫痫的有效性和安全性.方法 计算机检索PubMed、Embase和Cochrane图书馆数据库,搜集抗癫痫药物治疗难治性局灶性癫痫的随机对照试验,检索时限从数据库建立到2024年11月1日.结果 共纳入56篇文献,涉及57项随机对照试验,包括15 667例患者.网状Meta分析结果显示:与安慰剂相比,噻加宾[RR=3.43,95％CI(1.91,6.14)]、托吡酯[RR=2.61,95％CI(2.11,3.23)]、左乙拉西坦[RR=2.28,95％CI(1.84,2.83)]、唑尼沙胺[RR=2.28,95％CI(1.70,3.08)]、卢非酰胺[RR=2.28,95％CI(1.24,4.19)]、奥卡西平[RR=2.10,95％CI(1.61,2.74)]、氨己烯酸[RR=2.06,95％CI(1.28,3.30)]、加巴喷丁[RR=2.02,95％CI(1.51,2.70)]、普瑞巴林[RR=2.00,95％CI(1.60,2.50)]、苯巴那酯[RR=1.97,95％CI(1.40,2.76)]、拉莫三嗪[RR=1.85,95％CI(1.09,3.12)]、拉考沙胺[RR=1.78,95％CI(1.51,2.10)]、醋酸艾司利卡西平[RR=1.75,95％CI(1.43,2.14)]和布瓦西坦[RR=1.74,95％CI(1.37,2.21)]均能提高50％应答率,差异具有统计学意义(P＜0.05).在累积排序曲线下面积方面,噻加宾的治疗效果最佳,其次为托吡酯、左乙拉西坦和唑尼沙胺,治疗效果排名靠后的三种抗癫痫药物是吡仑帕奈、醋酸艾司利卡西平及布瓦西坦.此外,醋酸艾司利卡西平、吡仑帕奈、拉莫三嗪等抗癫痫药物的头晕副作用较大.结论 推荐使用噻加宾、托吡酯、左乙拉西坦和唑尼沙胺等抗癫痫药物治疗难治性局灶性癫痫患者.
Abstract
Objective To assess the effectiveness and safety of anti-seizure medication(ASMs)for refractory partial-onset seizures.Methods The PubMed,Embase and The Cochrane Library were searched to collect randomized controlled trials(RCTs)related to ASMs for refractory partial-onset seizures from the inception of the database to November 1,2024.Results 56 literature were included,involving 57 RCTs and 15,667 patients.Network Meta-analysis showed that when compared with placebo,tiagabine[RR=3.43,95％CI(1.91,6.14)],topiramate[RR=2.61,95％CI(2.11,3.23)],levetiracetam[RR=2.28,95％CI(1.84,2.83)],zonisamide[RR=2.28,95％CI(1.70,3.08)],rufinamide[RR=2.28,95％CI(1.24,4.19)],oxcarbazepine[RR=2.10,95％CI(1.61,2.74)],vigabatrin[RR=2.06,95％CI(1.28,3.30)],gabapentin[RR=2.02,95％CI(1.51,2.70)],pregabalin[RR=2.00,95％CI(1.60,2.50)],cenobamate[RR=1.97,95％CI(1.40,2.76)],lamotrigine[RR=1.85,95％CI(1.09,3.12)],lacosamide[RR=1.78,95％CI(1.51,2.10)],eslicarbazepine acetate[RR=1.75,95％CI(1.43,2.14)]and brivaracetam[RR=1.74,95％CI(1.37,2.21)]showed statistically significant effectiveness in achieving a 50％response rate(P＜0.05).According to the surface under the cumulative ranking curve,tiagabine had the optimal result of therapy,followed by topiramate,levetiracetam and zonisamide.The three ASMs exhibiting the poorest therapeutic were perampanel,eslicarbazepine acetate,and brivaracetam.In addition,the side effects of epilepsy medications such as eslicarbazepine acetate,perampanel and lamotrigine were more pronounced,particularly regarding dizziness.Conclusion This study recommended the use of tiagabine,topiramate,levetiracetam,and zonisamide for patients to treat refractory partial-onset seizures.
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