外来慢性難治てんかん患者に対するcarbamazepineによる単剤治療の効果

A Monotherapy with Carbamazepine on Outpatients with Chronic Uncontrolled Epilepsy

　抄録　発作未消失の外来慢性てんかん患者に，carbamazepine単剤治療を行い，良好な治療成績が得られたので報告する。対象は26例で，平均年齢35.6歳，初発年齢平均17.3歳。全例が部分てんかん（24例が複雑部分発作，2例が単純部分発作から二次性全般発作に移行）だった。〈結果〉（1）CBZ単剤治療に変更前の薬物の種類は平均2.4剤で，脳波は正常が2例，境界が2例，軽度異常が15例，中等度異常が6例で，てんかん波は13例に見られた。（2）CBZ単剤増量の治療により，著明改善が16例（62％）（うち発作消失は9例），改善が1例（4％），不変が9例（34％）で，悪化はなかった。（3）脳波の変化は，改善が4例，不変が21例，悪化が1例で，脳波改善は発作改善例に多かった。（4）CBZ平均投与量は655.6±255.1mg/day，11.5±5.2mg/kg/day，平均血中濃度は10.1±3.1μg/ml。（5）出産時障害，脳脊髄膜炎とその疑いの既往，CT異常および発作性自動症を有する例では，治療成績で不変が多かった。（6）部分てんかん（特に複雑部分発作）の大半の症例は，血中濃度モニターによる充分量のCBZ単剤治療で，発作が抑制されると考えられた。

　In outpatients with chronic epilepsy whose seizures were uncontrolled with conventional antiepileptic drug (AED) therapy, polytherapy was changed to monotherapy with carbamazepine and the results are herein reported. (1) 26 patients, 15 male and 11 female, average age 35.6±12.5 years, average age at onset 17.3±11.1 years, were studied. All had partial epilepsy ; 24 had complex partial seizures and 2 had simple partial seizures to secondary generalized tonicclonic seizures. The average number of drugs before monotherapy was 2.41±1.1. In 17 of 26 patients (65%), the plasma concentrations of all measurable AED used before monotherapy were at subtherapeutic levels. EEGs before the therapy are as follows ; 2 cases were normal, 3 borderline, 15 slightly abnormal, 6 moderately abnormal. Epileptic abnormal EEGs were found in 12 cases ; 9 showed anterior temporal spikes and 3 diffuse sp & w complexes (laterality of epileptic abnormal EEGs was recognized in 3 cases). (2) The changes of seizure frequency with monotherapy are as follows. 16 cases (62%) showing a decrease of attacks of more than 75% including 9 cases (35%) whose attacks disappeared and 1 case showing a decrease of attacks of more than 50% (A-group), 9 cases (32%) showing less than 50% improvement (B-group). (3) EEGs were improved in 4 cases, unchanged in 21 cases and aggravated in 1 case. The incidence of temporal spikes in B-group was significantly higher than in A-group. A correlation between the change of the frequency of attacks and epileptic discharges was recognized. (4) The average dosage of CBZ was 655.6±255.1mg/day or 115±5.2mg/kg/day, and the average plasma concentration was 10.1±3.1μg/ml. The average dosage and the average level were 615.6±199.8mg/day and 9.4±2.4μg/ml in A-group, 711.1±358.5mg/day and 11.5±4.0μg/ml in B-group. (5) As to clinical results with the monotherapy and clinical factors, many unchanged cases were found in patients with difficult birth, abnormal CT scan, history of mild encephalitis and these facts were in agreement with those in previous reports. In many patients with ictal automatism, seizure frequency was generally unchanged.