Gates J R
Minnesota Epilepsy Group, P.A. 310 North Smith Avenue, No. 300, St. Paul, Minnesota, 55102.
Epilepsy Behav. 2000 Jun;1(3):153-9. doi: 10.1006/ebeh.2000.0071.
In 1991, Dodrill carefully reviewed the behavioral effects of antiepileptic drugs (AEDs) and concluded: "The area of behavioral effects of antiepileptic drugs is poorly defined, lacks recognized and validated methods of assessment, and has suffered from a number of methodological limitations, especially including the use of experimental designs which have led to the contamination of drug effects and subject effects" (1). He further observed that the best controlled study showed that the behavioral effects of AEDs were quite limited; the benzodiazepines had the most consistently favorable effect, but were of limited utility in epilepsy, because they were not typically administered on a long-term basis; carbamazepine was associated with a favorable behavior change, but this change was seen most consistently in nonepileptic subjects; relatively few studies of valproic acid had been conducted; phenytoin was not associated with either a consistently positive or consistently negative change; and the barbiturates were clearly associated with the most negative behavior change. Since Dodrill's review, eight new AEDs have been approved by the Food and Drug Administration (FDA) for use in the United States, thereby dramatically increasing the therapeutic options for patients with epilepsy. These new drugs also increase the complexity of choosing the ideal drug for any given patient. Certainly a critical component of the decision to initiate or continue a specific treatment is the side effect profile of the medication. In clinical practice, behavioral and cognitive side effects of the older AEDs are significant concerns. This paper reviews the clinically important behavioral and cognitive side effects of the more commonly used, established AEDs as well as the newer AEDs within the limits of currently available published peer-reviewed literature and clinical experience. Particular emphasis is given to subpopulations at risk.
1991年，多德里尔仔细回顾了抗癫痫药物（AEDs）的行为效应，并得出结论：“抗癫痫药物的行为效应领域定义不明确，缺乏公认且经过验证的评估方法，并且存在一些方法学上的局限性，特别是包括使用导致药物效应和受试者效应相互干扰的实验设计”（1）。他进一步观察到，控制最为严格的研究表明，AEDs的行为效应相当有限；苯二氮䓬类药物具有最一致的有利效应，但在癫痫治疗中的效用有限，因为它们通常不进行长期给药；卡马西平与行为的有利变化相关，但这种变化在非癫痫患者中最为一致；关于丙戊酸的研究相对较少；苯妥英钠与一致的积极或消极变化均无关联；而巴比妥类药物显然与最负面的行为变化相关。自多德里尔进行综述以来，美国食品药品监督管理局（FDA）已批准八种新型AEDs在美国使用，从而极大地增加了癫痫患者的治疗选择。这些新药也增加了为特定患者选择理想药物的复杂性。当然，决定开始或继续特定治疗的一个关键因素是药物的副作用情况。在临床实践中，较老的AEDs的行为和认知副作用是重大关注点。本文在现有已发表的同行评审文献和临床经验的范围内，综述了更常用的、已确立的AEDs以及新型AEDs临床上重要的行为和认知副作用。特别强调了有风险的亚人群。
