摘要：

目的 系统评价拉莫三嗪单药治疗青少年肌阵挛癫痫的有效性和安全性。方法 以juvenile myoclonic epilepsy、idiopathic generalized epilepsies、lamotrigine、antiepileptic drugs、random 等英文词汇计算机检索 1980 年 1 月 1 日-2017 年 12 月 31 日美国国立医学图书馆生物医学信息检索系统（PubMed）、荷兰医学文摘（EMBASE/SCOPUS）和 Cochrane 图书馆等数据库关于拉莫三嗪单药治疗青少年肌阵挛癫痫的临床指南、系统评价（包括 Meta分析）、随机对照临床试验、病例对照研究、回顾性队列研究、病例观察研究等，采用Jadad量表、Cochrane系统评价手册和 RevMan 5.3统计软件进行文献质量评价和 Meta 分析。结果 共获得英文文献 1220 篇，经剔除重复和不符合纳入标准者，最终纳入 6 篇高质量（Jadad 评分≥4 分）文献共 314 例青少年肌阵挛癫痫患者（拉莫三嗪单药治疗组 166 例，丙戊酸钠单药治疗组 148 例），包括 4 项随机对照临床试验和 2 项病例观察研究。Meta 分析结果显示，拉莫三嗪单药治疗组药物不良反应发生率低于丙戊酸钠单药治疗组（RR = 0.540，95%CI：0.320 ~ 0.910；P = 0.020），而癫痫发作频率减少＞50%比例组间差异无统计学意义（RR = 1.200，95%CI：0.870 ~ 1.650；P = 0.260）。结论 拉莫三嗪对青少年肌阵挛癫痫安全、有效，且疗效与丙戊酸钠相当、耐受性较好、不良反应较少，是青少年肌阵挛癫痫的首选药物，特别是女性患者尤其适用。但与其他抗癫痫药物联合应用的疗效尚待更高质量的临床研究证实。

关键词: 癫痫, 肌阵挛性, 青少年, 抗惊厥药, Meta分析

Abstract:

Objective To evaluate the efficacy and safety of lamotrigine in the treatment of juvenile myoclonic epilepsy (JME). Methods Retrieve relevant clinical guidelines, systematic review (including Meta-analysis), randomized controlled clinical trials, case-control studies, retrospective cohort studies and case observation studies on lamotrigine treating JME from online databases (January 1, 1980-December 31, 2017) as PubMed, EBMASE/SCOPUS and Cochrane Library with key words: juvenile myoclonic epilepsy, idiopathic generalized epilepsies, lamotrigine, antiepileptic drugs, random. Jadad Scale, Cochrane System Evaluation Handbook and RevMan 5.3 statistical software were used for quality assessment and Meta-analysis. Results The research enrolled 1220 articles, from which 6 studies with Jadad score ≥ 4 (4 randomized controlled clinical trials and 2 case observation studies) were chosen after excluding duplicates and those not meeting the inclusion criteria. A total of 314 JME patients (166 cases treated by lamotrigine and 148 cases treated by valproate) were enrolled in 6 studies. Meta-analysis showed the occurrence rate of adverse reaction in lamotrigine group was significantly lower than that in valproate group (RR = 0.540, 95% CI: 0.320-0.910; P = 0.020), but there was no significant difference on rate of epileptic seizures decreasing > 50% (RR = 1.200, 95% CI: 0.870-1.650; P = 0.260). Conclusions Lamotrigine is safe and effective in the treatment of JME. It has better tolerance and less adverse reaction, and its effect is similar to that of valproate. It is the first choice for patients with JME, especially foradolescent female patients with JME. However, there is still lack of high-quality trials to confirm whether the combination with other drugs has any benefit in terms of efficacy. 

Key words: Epilepsies, myoclonic, Adolescent, Anticonvulsants, Meta-analysis