症候性局在関連性てんかんにおける薬剤整理が発作に与える影響—精神科てんかん外来患者における発作の有無と頻度を指標に

Effects of Minimization of Anti-epileptic Drugs on Seizures in Adult Outpatients with Symptomatic Localization-related Epilepsy

【抄録】　北海道大学医学部附属病院精神科神経科に通院中の376例の症候性局在関連性てんかん患者を対象に，2年間に主剤を決定し，他の併用薬剤を減量中止するという薬剤整理を行い，発作に与える影響を検討した。加齢化による影響を補正しても，薬剤数の減少に伴って発作が抑制される症例が有意に増加した。減薬により単純／複雑部分発作が有意に改善したが，二次性全般化発作の変化は明らかでなかった。下位分類別に見ると，単純／複雑部分発作の減少は側頭葉てんかんに明らかであった。薬剤数の減少とともに残った薬剤の増量が認められ，この2つの要因に相関がみられた。単剤で発作が抑制された症例の分析から，抗てんかん薬の薬効は症候性局在関連性てんかんの下位分類によって異なることが示唆された。

　The effects of minimization of anti-epileptic drugs (AEDs) on seizures were studied for two years in the 376 outpatients with symptomatic localization-related epilepsy, who are treated at Department of Psychiatry and Neurology. Hokkaido University Hospital. The mean number of AEDs was reduced from 2.09 to 1.65, and in spite of compensation for aging, the ratio of the patients who had seizures, was reduced from 53.8% to 48.7% during 2 years. In the 261 patients who received drugs in combination, the AED minimization apparently reduced simple and/or complex partial seizures, but not secondarily generalized seizures.

　In these 261 patients, there was no difference in terms of age, sex, and seizure frequency between the AED minimization and the non-minimization groups, however, the non-minimization group had a long clinical history. In the 70 patients with temporal lobe epilepsy, the AED minimization reduced the frequency of simple and/or complex partial seizures, but not of secondarily generalized seizures. In the 54 patients with frontal lobe epilepsy, the AED minimization altered neither the simple and/or complex seizures nor the secondarily generalized seizures. In the 50 patients who became free of seizures within the two years, a decrease in the number of drugs and an increase in the dose of the residual drugs were found, and these two factors were statistically correlated. In the 112 patients who were free of seizures due to monotherapy, the administrated drugs were CBZ 59.1% ＞ PHT 27.3% ＞ VPA 4.5% for temporal lobe epilepsy; PHT 42.9% ＞ VPA 21.4% ＞CBZ 7.1% for frontal lobe epilepsy : and CBZ 53.8% ＞ VPA 23.1%＞PHT 7.7% for occipital lobe epilepsy.

　These data suggest that the efficacy of AEDs may differ for the different sub-classifications of symptomatic localization-related epilepsy.