[公告]每月一主题---抗癫痫药物的选择每月一主题---抗癫痫药物的选择给大家发表意见的指引欢迎各位朋友共同分享经验，共同提高！1.依据发作的型态选择何种抗癫痫药？2.老年人癫痫患者药物的选择？3.肝肾功能不佳或者如何选择抗癫痫药？4.怀孕或哺乳女性抗癫痫药物的选择？5.卒中患者抗癫痫药物的使用原则？6.SAH或AVM患者抗癫痫药物的使用原则？7.脑瘤患者抗癫痫药物的选择？8.各国指南如何指引抗癫痫药物的选择？(AAN, EFNS, ILAE, NICE or SIGN及本国)Re:[公告]每月一主题---抗癫痫药物的选择和大家一起复习抗癫痫药物的应用不同类型癫痫需不同药物癫痫有多种类型，不同发作类型需要不同药物。

有些药物只对部分性发作有效，有些则对部分性发作和全身性发作都有效。

例如，乙琥胺只对全身性发作有效。

在美国经临床研究证明，丙戊酸钠、卡马西平、苯妥英、苯巴比妥和去氧苯比妥都能有效控制部分性发作。

非班酯、加巴喷丁、拉莫三嗪、托吡酯、硫加宾、奥卡西平、左乙拉西坦和唑尼沙胺等新药对部分性发作也有效。

研究还表明，对全身性发作有效的药物相对较少。

那些对部分性发作和全身性发作均有效的药物称为广谱抗惊厥药，包括：丙戊酸钠，拉莫三嗪，唑尼沙胺和非班酯。

辨别特异的癫痫综合征对选择药物有重要指导作用。

婴儿痉挛是一种年龄依赖性的癫痫综合征，主要影响出生一年内的婴儿，使用丙戊酸钠、促肾上腺皮质激素、糖皮质激素是最佳的治疗方法；伦－格综合征是一种儿童期的年龄依赖性癫痫，最好使用丙戊酸钠、苯二氮卓类、拉莫三嗪或非班酯治疗；儿童失神性癫痫最好使用丙戊酸钠或乙琥胺治疗；青年型肌阵挛性癫痫通常使用丙戊酸钠可以有很好的疗效。

有些药物可能加重某些癫痫类型的症状。

例如，对失神性癫痫的患者使用卡马西平会明显加重失神性癫痫症状；对全身性发作患者使用硫加宾与非惊厥性癫痫持续状态有关。

所以，判断和了解患者的癫痫发作类型和特异性癫痫综合征对药物选择具有重大意义。

由于丙戊酸钠对各种类型的癫痫都有效，当癫痫类型不能确定时，丙戊酸钠是一种安全有效的选择。

Re:[公告]每月一主题---抗癫痫药物的选择Early View publication March 9, 2009. EpilepsiaLong-term antiepileptic drug therapy contributes to the acceleration of atherosclerosis长期抗癫痫治疗加速了动脉粥样硬化的形成ABSTRACTPurpose: Long-term antiepileptic drug (AED) therapy has been associated with an increase in risk of atherosclerosis. At issue is whether this risk is related to the duration of AED therapy. We evaluated the hypothesis that the cumulative effect of long-term exposure to AEDs plays a pivotal role in the pathogenesis of atherosclerosis in patients with epilepsy.目的：长期抗癫痫治疗与增加动脉动脉粥样硬化的风险有关。

这一风险是否和持续抗癫痫治疗有关是有争议的。

我们评估了长期抗癫痫治疗癫痫药物的在中枢的蓄积作用对动脉粥样硬化形成影响。

Methods: One hundred ninety-five patients under long-term AED therapy and 195 healthy age- and sex-matched control subjects received measurement of intima media thickness (IMT) at the far wall of the common carotid artery (CCA) by B-mode ultrasonography to assess the extent of atherosclerosis.Other measurements included body mass index (BMI) and blood lipid profile or homocysteine, folic acid, uric acid, fasting blood sugar, high sensitivity C-reactive protein (hs-CRP), thiobarbituric acid reactive substances (TBARS), and total reduced thiols.方法: 195名长期抗癫痫治疗的患者,195个健康的在年龄,性别相配的对照受试者普遍接受通过超声检查颈总动脉壁内膜的厚度以评价动脉粥样硬化的程度.我们的测量包括体重指数(BMI),血脂或高半胱氨酸, 叶酸, 尿酸,空腹血糖, 超敏C反应性蛋白, 丙二酰硫脲化学反应的物质, 和减少的巯基化合物的总量.Results: CCA IMT was significantly increased in patients with epilepsy, with male subjects exhibiting thicker IMT than their female counterparts. 结果: 颈总动脉壁内膜的厚度增厚在癫痫患者中有统计学意义.在相同情况下IMT男性高于女性化合,Whereas BMI, homocysteine, hs-CRP, and TBARS were significantly elevated, folic acid and thiols weresignificantly reduced in patients with epilepsy. Multiple linear regression analysis further revealed that duration of AED therapy, age, gender, and TBARS level (index for oxidative stress) were independently associated with CCA IMT.体重指数(BMI) 高半胱氨酸,超敏C反应性蛋白, 丙二酰硫脲化学反应的物质,是明显提高的，叶酸和硫醇在癫痫患者中明显减少，多元线性回归分析进一步显示持续的抗癫痫治疗年龄，性别和TBARS水平（氧化应激）对动脉粥样硬化是独立的因素In addition, the log-transformed CCA IMT increased linearly with duration of AED therapy after adjustments for age, gender, and TBARS level.另外, 调整年龄,性别, TBARS 水平后记录长期的抗癫痫治疗后颈总动脉壁内膜的线性增厚的程度。

Discussion: The duration of AED therapy is significantly associated with the acceleration of atherosclerosis in patients with epilepsy, alongside independent contributions of age, gender, and oxidative stress to the atherosclerotic process讨论: 持续抗癫痫治疗对于加速癫痫患者的动脉粥样硬化是有统计学意义的，年龄、性别、和氧化应激对动脉粥样硬化是独立的因素。

Re:[公告]每月一主题---抗癫痫药物的选择Antiepileptic Drug Therapy and Its Management in Sudden Unexpected Death in Epilepsy: ACase–Control Study抗癫痫治疗和在癫痫症中意外死亡的处理.一项病例对照研究.ABSTRACTSummary: 摘要Purpose: Because frequent seizures constitute a major risk factor for sudden unexpected death in epilepsy (SUD EP), the treatment with antiepileptic drugs (AEDs) may play a role for the occurrence of SUDEP. We used data from routine therapeutic drug monitoring (TDM) to study the association between various aspects of AED treatment and the risk of SUDEP.目的:因为癫痫中,频繁发作是猝死的高危因素(SUD EP),应用抗癫痫药物防止癫痫患者猝死的发生有一定的作用.我们使用药物治疗检测的数据(TDM)从不同的方面研究抗癫痫治疗与猝死风险之间的关系.Methods: A nested case–control study was based on a cohort consisting of 6,880 patients registered in the Stockholm CountyIn Ward Care Register with a diagnosis of epilepsy. Fifty-seven SUDEP cases, and 171 controls, living epilepsy patients, were selected from the cohort. Clinical data including data on TDM were collected through medical record review.方法:一项嵌套的病例分析,以斯德哥尔摩的监护中心记录的6,880名癫痫患者的数据为基础的对照研究.57名癫痫猝死, 从群中选出的,现存的癫痫患者,171名对照者.通过病历回顾,包括关于治疗药物监测数据的临床资料均被收集.Results: relative risk (RR) of SUDEP was 3.7 (95% CI, 1.0–13.1) for outpatients who had no TDM compared with those who had one to three TDMs during the 2 years of observation结果:对于没有进行治疗药物监测的门诊病人与那些在两年内曾1到2次进行治疗药物监测者相比,癫痫突然猝死的相对危险度是3.7 (95% CI, 1.0–13.1)RR was 9.5 (1.4–66.0) if carbamazepine (CBZ) plasma levels at the last TDM were above and not within the common target range (20–40 μM).如果卡马西平血浆浓度持续高于或是不在共有效血药浓度(20–40 μM)之间.RR是9.5 (1.4–66.0)High CBZ levels were associated with a higher risk in patients receiving polytherapy and in those with frequent dose changes.对于服用多种抗癫痫药物者, 高的卡马西平的浓度是猝死的高危因素,和他们频繁的改变服药剂量有关. Although the subgroup of patients with high CBZ levels was small (six cases of 33 with CBZ therapy), and the result should be interpreted with caution, no similar associations were demonstrated for phenytoin plasma levels and risk of SUDEP.尽管小的亚组中病人有高的卡马西平的浓度(33例中6例给予卡马西平治疗),结果应该给予小心的解释,表明苯妥英的药物浓度和猝死的高危因素无关.No association was found between SUDEP risk and within-patient variation in AED levels over time.没有发现癫痫患者猝死风险和患者过去抗癫痫药物浓度的变化有关Conclusions: Polytherapy, frequent dose changes, and high CBZ levels as identified risk factors for SUDEP all point to the risks associated with an unstable severe epilepsy. It is unclear whether high CBZ levels per se represent a risk factor or just reflect other unidentified aspects of a severe epilepsy.结论: 多药疗法, 频繁的改变剂量,和高的卡马西平的浓度是已鉴定的癫痫患者猝死的高危因素,所有的要点是对于不稳定的严重的癫痫患者.卡马西平浓度本身是猝死的高危因素或是仅仅反映了严重癫痫的未经确认的某一方面,这一观点是不清楚的.Our results, however, prompt further detailed analyses of the possible role of AEDs in SUDEP in larger cohorts and suggest that reasonable monitoring of the drug therapy may be useful to reduce risks.我们的结论,无论如何, 在大的队列中,提示关于抗癫痫药物在癫痫患者突然猝死中所起的作用的更多的详细的分析,建议合理的血药浓度的监控可能减少猝死风险.________________________________________Accepted January 12, 2001.DIGITAL OBJECT IDENTIFIER (DOI)10.1046/j.1528-1157.2001.22000.x About DOI老年人癫痫患者药物的选择？Trends in antiepileptic drug prescribing for older patients with new-onset epilepsy点击下载Conclusions: Despite a growing list of clinical recommendations and guidelines, phenytoin wasthe most commonly used antiepileptic drug, and there was little change in its use for elderlypatients over 5 years.Summary of clinical guidelines and clinical recommendations for antiepileptic drugs (AEDs) in older patients with epilepsySIGN: LTG may be advantageousNICE: Same as other adultsILAE: LTG and GBP preferred first-line AED; CBZ alternate first-line AED; weak efficacy/effectiveness data to support use of VPA or TPM as first-line AEDKarceski et al.:AED of choice: LTG; other first-line AEDs: LEV, GBP, CBZ, OXCSemah et al.:AEDs of choice: GBP, LTGLamotrigine seems to be the preferred first-line AED used in the elderly by most guidelines.Re:[公告]每月一主题---抗癫痫药物的选择肿瘤患者的抗癫痫治疗一篇综述可以看看若从和化疗药物交互作用的角度，建议合适的AED是Vigabatrin、Gabapentin、Levetiracetam和Pregabalin。