摘要：

目的: 对比左乙拉西坦与奥卡西平单药治疗局灶性癫痫的临床疗效及安全性。方法: 选择2020年10月至2022年10月福建省立医院诊断与治疗的476例局灶性癫痫患者，分为左乙拉西坦组（275例）和奥卡西平组（201例），均持续治疗12个月，分析两组及不同亚组的总有效率和不良反应发生率。结果: 左乙拉西坦组总有效率为57.82%（159/275），奥卡西平组总有效率为46.77%（94/201），左乙拉西坦组高于奥卡西平组（χ²=5.696，P=0.017）。不同年龄的局灶性癫痫患者左乙拉西坦总有效率差异有统计学意义（χ²=6.785，P=0.034），其中，青年患者总有效率高于未成年患者（χ²=3.898，P=0.048）和中老年患者（χ²=4.946，P=0.026）。发病后首次影像学正常的局灶性癫痫患者左乙拉西坦总有效率（χ²=5.349，P=0.021）和奥卡西平总有效率（χ²=10.036，P=0.002）均高于影像学异常患者。同一亚组不同药物疗效分析：对于青年局灶性癫痫患者，左乙拉西坦总有效率高于奥卡西平（χ²=6.591，P=0.010）。左乙拉西坦组有13例（4.73%）出现不良反应，奥卡西平组有19例（9.45%）出现不良反应，奥卡西平组高于左乙拉西坦组（χ²=4.135，P=0.042）。结论: 与奥卡西平单药治疗相比，左乙拉西坦单药治疗局灶性癫痫的临床疗效较好，且对于青年患者疗效更佳，不良反应发生率较低；发病后首次影像学正常的局灶性癫痫患者两种药物疗效均优于影像学异常患者。

关键词: 癫痫，部分性, 左乙拉西坦, 奥卡西平, 药物相关性副作用和不良反应

Abstract:

Objective: To compare the clinical efficacy and safety of levetiracetam and oxcarbazepine in the treatment of focal epilepsy. Methods: A total of 476 patients with focal epilepsy treated at Fujian Provincial Hospital from October 2020 to October 2022 were selected. Based on their medication, they were divided into the levetiracetam group (n = 275) and the oxcarbazepine group (n = 201). Both groups underwent continuous treatment for 12 months. The overall effective rate and incidence of adverse reactions in both groups and different subgroups were analyzed. Results: The overall effective rate in the levetiracetam group was 57.82% (159/275), and in the oxcarbazepine group was 46.77% (94/201). The overall effective rate in the levetiracetam group was higher than that in the oxcarbazepine group (χ² = 5.696, P = 0.017). Efficacy analysis of levetiracetam monotherapy across different age subgroups showed statistically significant differences (χ² = 6.785, P = 0.034), with the overall effective rate in younger patients being higher than that in minors (χ² = 3.898, P = 0.048) and middle-aged/older patients (χ² = 4.946, P = 0.026). Levetiracetam was more effective in patients with initially normal imaging compared to those with abnormal imaging (χ² = 5.349, P = 0.021). In the oxcarbazepine monotherapy subgroup analysis, oxcarbazepine was also more effective in patients with initially normal imaging (χ² = 10.036, P = 0.002). Efficacy analysis of the same subgroup with different medications indicated that for younger patients with focal epilepsy, levetiracetam was superior to oxcarbazepine (χ² = 6.591, P = 0.010). In the levetiracetam group, 13 cases (4.73%) experienced adverse reactions, while the oxcarbazepine group had 19 cases (9.45%). The incidence of adverse reactions in the oxcarbazepine group was higher than that in the levetiracetam group (χ² = 4.135, P = 0.042). Conclusions: Compared to oxcarbazepine monotherapy, levetiracetam monotherapy demonstrated better clinical efficacy in treating focal epilepsy, particularly in younger patients. The incidence of adverse reactions in levetiracetam was lower. Both medications were more effective in patients with initially normal imaging compared to those with abnormal imaging.

Key words: Epilepsies, partial, Levetiracetam, Oxcarbazepine, Drug-related side effects and adverse reactions