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纽约路透社12月22日报道，一项新的研究表明，托吡酯是一种安全、有效的治疗夜食症的药物。

该研究结果发表于《临床精神病学杂志》11月刊上。该文作者、波士顿哈佛大学医学院John W. Winkelman博士称，“夜食症是一种集夜间反复醒来的睡眠失调症和白天强迫性饮食的饮食失调症于一体的行为失调症状。夜食症表现为夜间醒来后禁不住去饮食，且通常食用一些高热量食物。
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Winkelman博士对先后在一家睡眠障碍诊所应用托吡酯进行开放性试验治疗的夜食症患者病历做了回溯性研究。以第2版的“睡眠障碍国际分类法”作为诊断标准，疗效以“临床总体印象改善（CGI-I）积分”分为“非常显著”或“显著”。

共有30名患者给予托吡酯治疗，其中25名患者至少进行了一次随访。这25名患者平均年龄为44岁，76%为女性，发病平均年龄为25.2岁。在应用托吡酯治疗以前，所有患者每天晚上都有夜食经历，并且大多数患者每天晚上夜食不止一次。在平均为期11.6个月的治疗期间，托吡酯平均剂量为135mg。

“通过对CGI-I积分分析显示，25名患者中有17名患者（68%）显效，7名（28%）无效，1名（4%）恶化，” Winkelman博士在文章中说道。“28%（7/25）的患者体重减轻超过10%（15 kg、13.6 kg、9.1 kg、8.6 kg、6.8 kg、6.4 kg和5.0 kg）。

21名患者（84%）出现不良反应，最常见的不良反应为皮肤感觉异常（20%）、白天嗜睡（16%）和性功能低下（12%）；无严重的不良反应出现。41%（7/17）的显效患者平均12.4个月后停药。

“本次公开性试验表明，托吡酯确实能够给夜食症患者带来益处，尽管副作用限制了其耐受性，” Winkelman博士总结道。“尚需以治疗夜食症最小有效剂量的托吡酯，进行大样本的对照试验。”

Topiramate Is an Effective Treatment for Sleep-Related Eating Disorder

NEW YORK (Reuters Health) Dec 22 - Topiramate is safe and effective in the treatment of sleep-related eating disorder (SRED), according to a recent study.

"SRED is a behavioral disorder combining the repetitive nocturnal awakenings of a sleep disorder with the driven, compulsive eating of a daytime eating disorder," study author Dr. John W. Winkelman, of Harvard Medical School, Boston, writes in the November issue of the Journal of Clinical Psychiatry. "Sleep-related eating disorder is characterized by partial or full awakenings from sleep with compulsive eating, usually of high-calorie foods."

Dr. Winkelman conducted a retrospective chart review of consecutive patients treated in an open-label trial of topiramate for SRED in a sleeping disorders clinic. The second edition of the International Classification of Sleep Disorders was used to diagnose patients. Treatment response was defined as a rating of "very much" or "much" on the Clinical Global Impressions of Improvement (CGI-I) scale.

Overall, 30 patients were prescribed topiramate. Of these, 25 had at least one post-baseline follow-up appointment. The mean age of these 25 patients was 44 years, and 76% were female. The mean age at onset of SRED was 25.2 years. Before starting topiramate, all patients experienced nocturnal eating on a nightly basis, and most had multiple episodes of eating per night. The mean dose of topiramate was 135 mg over a mean of 11.6 months.

"Analysis of CGI-I scores revealed that 17 (68%) of 25 patients were considered responders, 7 (28%) of 25 were unchanged, and 1 (4%) of 25 was worse," Dr. Winkelman writes. "Twenty-eight percent (7/25) of patients lost greater than 10% of body weight (15 kg, 13.6 kg, 9.1 kg, 8.6 kg, 6.8 kg, 6.4 kg, and 5.0 kg).

Twenty-one patients (84%) reported adverse events. The most common adverse events were paresthesias (20%), excessive daytime sleepiness (16%), and sexual dysfunction (12%). There were no serious adverse events. Forty-one percent (7 of 17 patients) of responders discontinued topiramate after a mean of 12.4 months.

"Topiramate was found to be of substantial benefit in patients with SRED in this open-label case series, though adverse events limited its tolerability," Dr. Winkelman concludes. "Given the paucity of effective medication treatments for SRED, a controlled trial of topiramate in a larger sample of patients is indicated."

J Clin Psychiatry 2006;67:1729-1734.

http://www.medscape.com/viewarticle/549823

编辑：蓝色幻想