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50歳以上で発症した部分てんかん患者に対する25週間のレベチラセタム(LEV)付加投与の効果を実臨床下で検討した。有効性指標の全般改善度有効率(著明改善と改善)は98.72%(77/78例)で,評価期間4週間での50%レスポンダーレートと発作消失率は,それぞれ97.37%(74/76例)と84.21%(64/76例)であった。副作用発現率は12.38%(13/105例,16件)で,重篤な副作用は1例(躁病)で生じ,LEV服用継続率は96.00%であった。患者集団の特性,抗てんかん薬の使用法そして評価方法がLEVの高い有効性に影響した可能性があるが,高齢発症部分てんかん患者へのLEV付加投与は発作消失を達成する有用な選択肢の1つとなることが示唆された。
Abstract
This prospective, nationwide, specified drug use-results survey investigated the effects of levetiracetam (LEV) in elderly individuals with partial-onset seizures of advanced-age onset in a practical setting. Participants comprised LEV-naïve patients with onset of focal epilepsy at ≥50 years old and management by at least one antiepileptic drug. Efficacy measures were the physician-rated global improvement scale (GIS), and proportions of patients showing 50% and 100% seizure reduction by comparing seizure frequency during the 4-week pre-treatment period and the last 4 weeks of the 25-week treatment period. Adverse drug reactions (ADRs) and retention rate were also evaluated. Data for safety, GIS evaluation, and seizure frequency analyses were available from 105, 78, and 76, respectively, of 116 enrolled patients, 83 (71.55%) of whom were enrolled by neurosurgeons. Improvement rate (improved or markedly improved) as determined by GIS was 98.72% (77/78). Seventy-four (97.37%) and 64 patients (84.21%) showed 50% and 100% seizure reduction, respectively. Incidence of ADRs was 12.38%, including one serious ADR (mania). LEV retention rate remained high at the end of the 25-week treatment period (96.00%). LEV appears efficacious and well-tolerated in elderly patients with focal epilepsy. Including LEV in the treatment regimen may allow elderly patients to achieve freedom from seizures.
(Received November 21, 2014; Accepted January 29, 2015; Published June 1, 2015)
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