소아복잡부분발작 및 Benign Childhood Epilepsy with Centrotemporal Spike(BCECTS)에서 Carbamazepine 또는 Valproate 단독치료시 약제선택에 관여하는 인자에 대한 연구

A Clinical Study on Factors Influencing the Choice of Valproate and Carbamazepine as Monotherapy in Previously Untreated Childhood Patients with Partial Seizure

배경: 지금까지 carbamazepine과 valproate는 안전하고 모든 발작치료에 효과적인 약으로 알려져왔다. 그러나, 최근까지 valproate는 전신발작에, carbamazepine은 부분발작에 유효한 약으로 인식되어 있다. 방법:대상은 complex partial seizure와 benign childhood epilepsy with centrote-mporal spike로 처음으로 진단받은 58명으로 연령분포는 4개월에서 16세였다. 모든 환아는 carbamazepine 또는 valproate단독치료를 받았고, 혈중농도를 검사하여 용량을 조절했다. 추적관찰기간은 6개월에서 5년으로 평균 18개월이었다. 결과: 발작조절률이 carbamazepine 이 81.4%, valproate가 73.3%로 차이가 없었다. 복잡부분발작과 BCECTS에서 각각 두 항경련제의 효과를 비교해 본 결과, 복잡부분 발작에서는 두 약제간의 발작 조절률의 차이가 없었으나, BCE-CTS에서는 valproate보다 carbamazepine이 발작조절률에 있어 더욱 효과적이었다(P=0.025). 초기 발작간 뇌파소견, 치료전 발작기간 과 발작 횟수와 같은 요인들과 항경련제의 발작 조절률과는 유의한 관계는 없었다. 결론: 복잡부분발작치료에 carbamazepine과 valproate가의 효과차이는 없어 일차 선택약제로 모두 사용할 수 있으나, BCECTS환아인 경우 carbamazepine이 더욱 효과적이었다. 발작빈도 및 발작기간 등과 항경련제 선택과의유의한 관계는 없었으나, 뇌파가 focal epileptiform discha-rge를 보인 경우는 carbamazepine이 효과적이었고, Focal and generalized epileptiform disch-arge를 보인 경우는 valproate가 효과적인 경향을 보였으나 통계적인 의미는 없었다.

Background : Sodium valproate and carbamazepine have been well known as safe and effective drugs for the treatment of all types of epilepsy. Until recently there has been a widely held view, however. that valproate was best for primary generalized seizures. and carbamazepine for partial seizures. Method : This study enrolled a total of 58 children with newly diagnosed as having complex partial seizures(CPS) or beni후 childhood epilepsy with centrotemporal spike(BCECTS)(age range, 4months-16years). The patients were assigned to treatment with carbamazepine or divalproex sodium as monotherapy at doses adjusted to achieve therapeutic blood level. The mean period of observation was 18 months with a range of 6 months-5years. Result : The findings suggested that both carbamazepine and valproate were equally effective in the control of partial seizures(81.4% vs 73.3%). When the analysis was repeated separately for complex partial seizure and benign childhood epilepsy with centrotemporal spike(BCECTS), no significant differences of efficacy between two drugs were found in patients with complex partial seizures, however, charbamazepine was more efficacious than valproate in patients with BCECTS (P=0.025). No correlation between initial interictal EEG findings, duration of seizures and frequency of seizures prior to treatment and seizure control rate of each drugs was found. Conclusion : Both drugs ar equally effective in the control of partial seuzres and can be prescribed as an anticonvulsant of first choice, however, carbamazepine is more efficacious than valproate in patients with BCECTS. The duration of seizures and frequency of seizures prior to treatment are not related to the choice of antiepileptic drugs, but carbamazepine tends to be effective in the paitnes with showing focal epileptiform discharges in the initial interictal EEG wheras valproate tends to be effective in the patients with having focal and generalized epileptiform discharges: however, such result is not significant statistically.