Wolf Peter
Epilepsy Centre Bethel, Bielefeld, Germany.
Epilepsia. 2002;43 Suppl 9:2-5. doi: 10.1046/j.1528-1157.43.s.9.2.x.
Nonpharmacologic conservative treatments receive too little attention. Depending on the clinical condition of the patients, they may be used alone or in conjunction with other therapies. Their target is the single seizure rather than the epileptic condition as such. They belong mainly to one of three domains. NONSPECIFIC PREVENTION OF SEIZURES: The first step is the identification of factors facilitating the occurrence of seizures. In the second step, strategies to control these factors are developed. Most common are disturbances of the sleep-wake cycle, especially reduction of sleep. Patients should follow a regular sleep schedule with deviations of not >2 h. Sometimes a sleep calendar is helpful. Night shifts are not compatible with seizure prevention in these cases. Sleep disturbances as a facilitating factor of seizures are particularly common in juvenile idiopathic generalized epilepsies, in which their avoidance is in many cases an indispensable part of the therapeutic regimen, along with appropriate drug treatment. They are the most common precipitating factor in adolescents and adults with a first epileptic [mostly generalized tonic-clonic (GTC)] seizure. In these instances, their avoidance is central to the secondary prevention of epilepsy developing from the single seizure, whereas the prescription of antiepileptic drugs (AEDs) is rarely effective. Other nonspecific facilitators of seizures include uncontrolled use of alcohol and extraordinary stress. Patients must learn how to cope with stressful events. SPECIFIC PREVENTION OF SEIZURES: In reflex epilepsies, specific precipitants of seizures are the targets of interventions. Thus, most patients with primary reading epilepsy begin to have, with prolonged reading, perioral reflex myoclonias, which enable them to stop reading and thus to avoid a GTC seizure. In photosensitive patients, seizures are often precipitated by television. These can be avoided by viewing from a distance and using a remote control, small screens in a well-lit room, and preferably with a 100-Hz line shift. Environmental flicker stimulation often comes unexpectedly, and it is advisable that the patients always wear sunglasses in brightly lighted surroundings. Polarized glasses seem to be more protective than plain sunglasses. If the patient has only photically induced seizures, treatment by specific prevention alone may be sufficient, but if spontaneous seizures also occur, drugs must be given in addition. ARREST OF SEIZURES: Focal seizures that develop sufficiently slowly to leave the patient time to react may be interrupted by "countermeasures." These, again, may be nonspecific (acting by relaxation, concentration, or a combination of both) or specific. The latter are individually tailored, based either on spontaneous experiences of the patient or on the anatomy of ictogenesis. Seizure propagation is blocked when a major part of the neurons involved is activated and not recruitable for spread of the epileptic discharge. Seizure arrest rarely is used alone but usually in combination with partially successful pharmacotherapy.
非药物保守治疗受到的关注过少。根据患者的临床状况，它们可以单独使用或与其他疗法联合使用。它们的目标是单次发作，而非癫痫本身。它们主要属于三个领域之一。癫痫发作的非特异性预防：第一步是识别促发癫痫发作的因素。第二步是制定控制这些因素的策略。最常见的是睡眠 - 觉醒周期紊乱，尤其是睡眠减少。患者应遵循规律的睡眠时间表，偏差不超过2小时。有时睡眠日历会有所帮助。在这些情况下，夜班与癫痫预防不相容。睡眠障碍作为癫痫发作的促发因素在青少年特发性全身性癫痫中尤为常见，在许多情况下，避免睡眠障碍是治疗方案中不可或缺的一部分，同时还需进行适当的药物治疗。它们是首次发生癫痫发作（大多为全身性强直 - 阵挛发作）的青少年和成人中最常见的促发因素。在这些情况下，避免睡眠障碍是预防单次发作发展为癫痫的二级预防的关键，而使用抗癫痫药物（AEDs）很少有效。其他非特异性癫痫发作促发因素包括无节制饮酒和极度压力。患者必须学会如何应对压力事件。癫痫发作的特异性预防：在反射性癫痫中，癫痫发作的特定诱发因素是干预的目标。因此，大多数原发性阅读性癫痫患者在长时间阅读时会开始出现口周反射性肌阵挛，这使他们能够停止阅读从而避免全身性强直 - 阵挛发作。在光敏性患者中，癫痫发作通常由电视诱发。可以通过远距离观看、使用遥控器、在光线充足的房间里使用小屏幕，最好是采用100赫兹行频偏移来避免。环境闪烁刺激常常出乎意料地出现，建议患者在光线明亮的环境中始终佩戴太阳镜。偏振眼镜似乎比普通太阳镜更具防护作用。如果患者仅患有光诱发性癫痫发作，仅通过特异性预防进行治疗可能就足够了，但如果也发生自发性癫痫发作，则还必须给予药物治疗。癫痫发作的终止：发展足够缓慢以便患者有时间做出反应的局灶性癫痫发作可以通过“对策”来中断。这些对策同样可能是非特异性的（通过放松、集中注意力或两者结合起作用）或特异性的。后者是根据患者的自发经验或癫痫发作起源的解剖结构进行个体化定制的。当涉及的大部分神经元被激活且无法用于癫痫放电传播时，癫痫发作的传播就会被阻断。癫痫发作终止很少单独使用，通常与部分有效的药物治疗联合使用。
