Iudice A, Murri L
Department of Neurosciences, Section of Neurology, University of Pisa, Italy.
Drugs. 2000 May;59(5):1091-9. doi: 10.2165/00003495-200059050-00005.
Early and late epileptic seizures are a frequent complication of severe head traumas. The administration of anticonvulsant drugs immediately after head injury is commonly implemented as a prophylactic measure; however, there is a lack of consensus on the usefulness of prophylaxis with anticonvulsants for the prevention of late post-traumatic epilepsy (PTE). The inconsistent evidence accumulated so far from clinical studies, most nonrandomised and uncontrolled in design, and the limited knowledge of the processes underlying post-traumatic epileptogenesis, do not warrant empirical pharmacological prophylaxis with long term administration of conventional anticonvulsants. Phenytoin and phenobarbital (phenobarbitone) are used to a large extent in this indication. As a general rule, a benefit/risk analysis in individual patients should drive prophylactic drug prescription in PTE as it can have potential detrimental effects on a patient's recovery. New compounds, such as free-radical scavengers and antiperoxidants, show encouraging experimental results, but their clinical use is still very limited.
早期和晚期癫痫发作是严重头部创伤常见的并发症。头部受伤后立即给予抗惊厥药物通常作为一种预防措施；然而，对于使用抗惊厥药物预防晚期创伤后癫痫（PTE）的有效性，目前尚无共识。迄今为止，从临床研究中积累的证据并不一致，大多数研究在设计上是非随机和无对照的，而且对创伤后癫痫发生的潜在机制了解有限，因此不支持长期使用传统抗惊厥药物进行经验性药物预防。苯妥英和苯巴比妥（鲁米那）在很大程度上用于这一适应症。一般来说，对个体患者进行获益/风险分析应指导PTE的预防性药物处方，因为它可能对患者的恢复产生潜在的不利影响。新的化合物，如自由基清除剂和抗氧化剂，显示出令人鼓舞的实验结果，但它们的临床应用仍然非常有限。
