摘要
目的分析老年患者丙戊酸钠（VPA）脑病的临床特点，提高对丙戊酸钠脑病的认识。方法回顾性分析我院2003年4月至2011年4月诊治的10例老年VPA脑病患者的临床表现、生化、脑电图（EEG）变化及治疗结果，并结合文献进行总结。结果10例患者中男性8例，女性2例；年龄65～88岁，平均（75．4±10．3）岁；10例中7例单用丙戊酸钠（VPA），另3例合用其他抗癫痫药（AEDs）；10例病例的血清VPA水平62．1～122．7mg／L，平均（92．3±30．1）mg／I。；共同临床表现均为意识障碍、认知功能下降；血氨水平56．7～225．1μmol／L，平均（101．4±55．2）μmol／L；肝功能均在正常范围；EEG主要表现为弥漫性的慢波增多，以θ和δ波占优，1例有癫痫样放电增多，1例合并有三相波；所有病例在停用VPA3421d后症状改善。结论VPA脑病在老年患者中并不罕见，突出表现是意识障碍、认知功能下降，多数VPA脑病预后良好，停药后可逐渐恢复正常。
Objective To analysis the clinical features of valproate （VPA）-induced encephalopathy in elderly people in order to improve our cognition toward it. Methods From March 2003 to March 2011, a total of 10 cases with VPA-induced encephalopathy were retrospectively reviewed and summarized. The data collected included clinical manifestations , biochemistry , EEG and therapeutic effects. Results In the 10 cases, 8 were males and 2 females. The age ranged from 65-88 years old （mean age 75.4±10.3 years）. 7 subjects were on treatment with VPA alone, and the other 3 in combination with other anti epileptic drugs. The serum VPA level in this study ranged from 62.1-122.7μg/ml with mean of （92.3 ± 30.1） mg/L （normal range 50-100 mg/L）. All subjects presented with confusion and cognitive impairment. The serum ammonia level in this study ranged from 56.7-225. 1 μmol/L with mean of （101.4±55.2） μmol/L （normal range 11-32 μmol/L）. All cases were with normal liver function. Electroencephalography was characterized by signs of severe encephalopathy with continuous generalized slowing, a predominance of θ and δ activity, occasional bursts of epileptiform discharges and triphasic waves. All cases were improved 3-21 days after VPA withdrawal. Conclusions VPA-induced encephalopathy that manifested in confusion and cognitive impairment is not uncommon in elderly patients and it has a good prognosis and the early withdrawal of VPA leads to improvement in almost all cases.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2013年第1期33-36,共4页
Chinese Journal of Geriatrics
关键词
丙戊酸
脑疾病
Valproic acid
Brain diseases
