脳神経外科領域で経験する難治性の症候性部分てんかん症例に対するレベチラセタム併用療法の有効性と安全性の検討

Efficacy and Safety of Levetiracetam as an Add-on Therapy for Symptomatic Refractory Epilepsy Treated in a Department of Neurosurgery

脳神経外科領域におけるてんかん症例では，原因疾患の進行などに伴い，コントロールに難渋するケースが経験される。当科において既存の抗てんかん薬（AED）内服下においても部分てんかん発作を認めた症候性てんかん患者12例に対し，レベチラセタム（LEV）1,000〜2,000mg/日を併用投与しその有用性と安全性について検討した。服用6カ月後の発作完全消失率は58％であった。発作完全消失群では全体的生活の質（QOL），エネルギーと倦怠感，自覚的健康状態のスコアの改善を認めた。LEVに起因する血液学的有害事象は認められなかった。LEVは脳神経外科領域の難治性の症候性部分てんかんに対し，安全で有効性の高いAEDと考えられた。

Abstract

The number of patients who suffer from symptomatic partial epilepsy is significant, and those who undergo neurosurgery often experience refractory seizures. Levetiracetam (LEV) is a new-generation anti epileptic drug (AED). Previous studies have shown that LEV has favorable efficacy and a good safety profile with few drug interactions, as it has a unique pharmacological mechanism and acts on synaptic vesicle protein. This study aimed at estimate the efficacy and safety of 1,000 to 2,000 mg/day of LEV as an add-on therapy for refractory symptomatic seizures treated in the department of neurosurgery of our hospital. Twelve patients with ＞1 seizure attack per year who were administrated one to three AED(s) and had never used LEV were enrolled in this study. The follow-up period was at least 6 months. Seizure-free ratio, health-related quality of life (QOL), and tolerability were assessed. Fifty-eight percent (7/12) of patients were seizure-free, and their “overall QOL”, “energy/fatigue” and “health status” distress-item scores in the QOLIE-31-P had improved. All patients were able to continue oral treatment with LEV without major side effects. Thus, the efficacy and safety of oral add-on LEV therapy were high for these patients.

(Received January 19, 2016; Accepted September 2, 2016; Published December 1, 2016)