目標:癲癇是一種需要長時間照護的慢性神經疾病,本研究藉由評估使用valproic acid(VAL)之情形,探討當癲癇獲得穩定控制時,年齡、性別等因子及單一治療、合併治療等不同治療策略與VAL使用劑量或血中濃度監測(TDM)結果之關係。
方法:本研究採回溯性評估某醫學中心於民國96年1月至12月之癲癇控制穩定患者使用VAL單一療法或合併療法之用藥情形,與血中濃度及臨床反應間關係,並比較不同性別及年齡等患者族群之差異性。
結果:該年度連續使用VAL達半年以上之患者共211人,排除年齡<=18歲小兒患者後,符合有進行TDM納入本研究進行分析共計85人。分析結果顯示大多數癲癇患者使用VAL的每日處方劑量(prescribed daily dose, PDD)低於目前文獻所記載之定義每日劑量(defined daily doses, DDD),且患者進行VAL治療中病情穩定之濃度監測的結果並非完全介於建議濃度之間。在VAL的使用劑量上,男性顯著性高於女性,且成年男性合併其他抗癲癇藥使用之比例較高。
結論:儘管該醫學中心之病情穩定患者使用VAL的劑量低於文獻記載之DDD,且並非所有患者之血中濃度皆介於建議治療濃度之間,但仍可有效的控制癲癇發作,顯示固定用藥時的常規性VAL血中濃度監測絕對需要性有待討論。
Purpose : This study was evaluated the valproic acid (VAL) prescribed doses, blood concentration levels and clinic therapeutic efficiency, under different patient subgroup factors such as genders and age effects.
Methods: A retrospective study was conducted at a medical center from January 2007 to December 2007. The stable epilepsy patients treated by VAL medicine and measured blood concentration were selected to analyzed.
Results: The VAL prescribed daily dose (PDD) was lower than the DDD for most cases. For PDD and combined therapy percentages, men’s group was significantly higher than that of female.
Conclusions: Although patients PDD and TDM results not well restricted in suggested normal range, epilepsy patients still under well control. Which mean the routine TDM for well- controlled epilepsy patients may need rethink about it.