청소년 근간대 뇌전증에서 발프로인산 하루 한번 투약 용법의 효용성과 안정성
Efficacy and Tolerability of Valproic Acid Once Daily Dosing for Juvenile Myoclonic Epilepsy
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목적: 청소년 근간대 뇌전증 환자에서 지속형 발프로인산 하루 한 번 용법의 효용성과 안정성에 대해 알아보고자 하였다 . 방법: 청소년 근간대 뇌전증으로 진단 받고 발프로인산 단독 요법을 진행한 21명 환자의 의무기록을 후향적으로 조사하였다 . 해당 환자들의 발병 연령, 과거력과 발달력, 진단 시 동반된 경련의 양상, 투여 용량, 치료에 대한 반응, 부작용에 대해서 조사하였으며 지속형 발프로인산을 하루에 한 번 투여한 군과 일반 제형 발프로인산을 하루 두번 투여한 군사이에 경련의 조절과 약물 순응도,부작용의 빈도를 비교 분석 하였다 . 결과: 지속형 발프로인산을 하루에 한 번 투여한 환자는 12명, 하루에 두 번 투여한 환자는 9명이었다 . 모든 환자에서 치료 후 근간대성 발작의 빈도는 50% 이상 감소하였으며 치료 6개월 이후에 근간대성 발작은 소실되었다 . 하루 한 번 용법 군의 모든 환자에서 전신 강직 간대 발작이 조절되었으며 하루 두 번 용법 군 중 3명의 환자에서2년의 관찰 기간 동안 전신 강직 간대 발작이 발생하였다 . 두 군 간에경련의 조절과 약물 순응도, 부작용의 빈도는 통계적으로 유의한 차이를 보이지 않았다 . 결론: 청소년 근간대 뇌전증에서 지속형 발프로인산의 하루 한 번 용법은 하루 두 번 용법과 비교하였을 때 경련의 조절과 부작용 발생측면에서 비슷한 결과를 보였다 . 지속형 발프로인산의 하루 한 번 용법을 통해 약물 복용의 편리함을 제공하고 약물 복용 순응도를 높일 수 있으며 궁극적으로 치료 성적의 향상을 기대할 수 있다.
Abstract
Purpose: The purpose of this study was to evaluate the efficacy and tolerability of extended-release valproic acid once daily dosing in juvenile myoclonic epilepsy (JME). Methods: Medical records of patients who received valproic acid monotherapy for the treatment of JME were retrospectively reviewed. Their clinical information regarding age, gender, seizure types, underlying neurologic status, dosing regimen, response to treatment, and adverse events related to valproic acid, were analyzed. Seizure control, compliance, and adverse events rates were compared between the group of once daily dosing and the group of twice daily dosing. Results: Twenty one patients (11 boys and 10 girls) were included in the study. Twelve patients were taking valproic acid extended-release once daily and nine patients were taking twice a day. More than 50% decrease in myoclonic seizure was achieved in all the patients in both groups. Generalized tonic-clonic seizure was controlled in all the patients who were taking once daily while 3 patients(36%, 3/8 patients) in twice daily group had breakthrough generalized tonic clonic seizures during the 2 year period of treatment. However, there were no statistically significant differences in seizure control, compliance, and adverse event rates between the two groups. Conclusion: This study demonstrated that valproic acid extended-release once daily dosing was as effective and tolerable as twice daily in the treatment of JME. Once daily dosing of valproic acid would be convenient which improve patient compliance and consequently bring better outcome in treatment of JME.
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