Meador Kimford J
Department of Neurology, Medical College of Georgia, Augusta, GA 30912, USA.
Neurology. 2002 Apr 23;58(8 Suppl 5):S21-6. doi: 10.1212/wnl.58.8_suppl_5.s21.
Although most patients with epilepsy have normal cognitive abilities, they are at increased risk for cognitive deficits. Multiple factors contribute to this risk including antiepileptic drugs (AEDs), which not only reduce neuronal irritability but may also impair neuronal excitability. The major cognitive effects of AEDs are impaired attention, vigilance, and psychomotor speed, but secondary effects on other cognitive functions can be seen. The adverse cognitive effects of AEDs are offset in part by reduced seizures. In general, the cognitive effects of AEDs are less than the sum total of other factors, but because AEDs are the major therapeutic modality for epilepsy, they are of special concern. AED-induced cognitive side effects are increased with rapid initiation, higher dosages, and polytherapy. Differential cognitive effects can be seen (e.g., worse performance on phenobarbital), but the magnitude of cognitive effects is relatively modest effects for most AEDs. However, even this modest effect can be clinically significant and impact the patient's quality of life. In addition, some patient groups may be at particular risk (e.g., elderly, children, fetus). The ultimate therapeutic goal is to control seizures with no or minimal side effects. The cognitive profile of an AED is but one factor in the selection of therapeutic options. Ongoing seizures can be detrimental to both cognition and quality of life. Patients who are refractory or intolerant to AED therapy should be referred for video EEG monitoring to confirm the seizure diagnosis and determine if the patient is a candidate for epilepsy surgery.
虽然大多数癫痫患者的认知能力正常，但他们出现认知缺陷的风险增加。多种因素导致了这种风险，包括抗癫痫药物（AEDs），这些药物不仅降低神经元兴奋性，还可能损害神经元的易激惹性。AEDs的主要认知影响是注意力、警觉性和精神运动速度受损，但对其他认知功能的次要影响也可见到。AEDs的不良认知影响部分被癫痫发作减少所抵消。一般来说，AEDs的认知影响小于其他因素的总和，但由于AEDs是癫痫的主要治疗方式，它们受到特别关注。AEDs引起的认知副作用会随着快速起始、高剂量和联合治疗而增加。可以看到不同的认知影响（例如，苯巴比妥的表现更差），但大多数AEDs的认知影响程度相对较小。然而，即使是这种较小的影响在临床上也可能很显著，并影响患者的生活质量。此外，一些患者群体可能处于特别风险中（例如，老年人、儿童、胎儿）。最终的治疗目标是在没有或只有最小副作用的情况下控制癫痫发作。AEDs的认知特征只是选择治疗方案时的一个因素。持续的癫痫发作对认知和生活质量都可能有害。对AED治疗难治或不耐受的患者应转诊进行视频脑电图监测，以确认癫痫发作诊断并确定患者是否适合癫痫手术。
