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目的探讨经颅磁刺激联合医痫丸辅助治疗颅脑外伤继发性癫痫的临床疗效及其可能的机制。方法选择颅脑外伤继发性癫痫患者132例,随机分为对照组、磁刺激组和联合组各44例。三组均予常规治疗(注射苯巴比妥钠或口服丙戊酸钠片,癫痫发作时口服氯硝西泮片)12周;磁刺激组在常规治疗的基础上行经颅磁刺激连续治疗1周;联合组在磁刺激基础上口服医痫丸,共12周。三组治疗12周评价临床疗效,计算总有效率。比较两组治疗前及治疗12周癫痫持续状态严重程度量表(STESS)评分及癫痫持续状态的发作持续时间、发作频率,生活质量调查表31(QOLIE-31)评分以及血清ROS、NF-κB、IL-1β、TNF-α水平(采用ELISA法检测)。记录三组治疗期间不良反应发生情况。结果对照组总有效率为70.45%,磁刺激组为75.00%,联合组为90.91%;联合组总有效率高于对照组及磁刺激组(P均<0.05)。三组治疗后STESS评分、发作持续时间、发作频率及血清ROS、NF-κB、IL-1β、TNF-α水平均低于治疗前,QOLIE-31评分均高于治疗前,但联合组变化更明显(P均<0.01),对照组与磁刺激组治疗后上述指标比较差异均无统计学意义(P均>0.05)。三组不良反应发生率比较差异均无统计学意义(P均>0.05)。结论经颅磁刺激联合医痫辅助治疗颅脑外伤性继发癫痫效果确切且较为安全;抑制氧化应激及炎性反应可能是其作用机制。
Objective To investigate the clinical effects of transcranial magnetic stimulation combined with medical epilepsy pill in the treatment of secondary epilepsy with craniocerebral trauma and its possible mechanism. Methods 132 cases of secondary epilepsy with traumatic brain injury were randomly divided into control group, magnetic stimulation group and the combined group of 44 cases. All of the three groups were given routine treatment (sodium phenobarbital injection or oral sodium valproate tablets, oral clonazepam epilepsy tablets) for 12 weeks; magnetic stimulation group in the conventional treatment based on continuous magnetic resonance transcranial 1 Weeks; combined group on the basis of magnetic stimulation oral epilepsy pills, a total of 12 weeks. Three groups of 12 weeks evaluation of clinical efficacy, calculate the total effective rate. The duration of seizure, seizure frequency, quality of life questionnaire 31 (QOLIE-31), serum levels of ROS and NF-κB were compared between the two groups before treatment and 12 weeks after treatment. , IL-1β, TNF-α levels (detected by ELISA). Record three groups of adverse reactions during treatment. Results The total effective rate was 70.45% in the control group, 75.00% in the magnetic stimulation group and 90.91% in the combined group. The total effective rate in the combined group was higher than that in the control group and the magnetic stimulation group (all P <0.05). STESS score, duration of attack, frequency of seizures and serum levels of ROS, NF-κB, IL-1β and TNF-α in three groups after treatment were lower than those before treatment, QOLIE-31 scores were higher than before treatment, but the combination group changed more (P <0.01). There was no significant difference between the control group and the magnetic stimulation group after treatment (P> 0.05). The incidence of adverse reactions in the three groups showed no significant difference (all P> 0.05). Conclusion Transcranial magnetic stimulation combined with epilepsy adjuvant treatment of traumatic brain injury secondary epilepsy is accurate and relatively safe; inhibition of oxidative stress and inflammatory response may be its mechanism of action.