Bazil Carl W
Comprehensive Epilepsy Center, Columbia University, New York, New York 10032, USA.
Epilepsia. 2004;45 Suppl 6:3-12. doi: 10.1111/j.0013-9580.2004.455002.x.
Traditionally, control of seizures in patients with epilepsy is viewed as the most important clinical outcome. Yet, current antiepileptic drugs (AEDs) do not always achieve this. Around 30-40% of patients remain uncontrolled despite pharmacological intervention. Poor tolerability of AEDs is a large part of the problem and contributes as much to the overall effectiveness of therapy as efficacy. Comorbid conditions are present in many patients, and appropriate management of these can further improve seizure control and quality of life. Patients with epilepsy often experience--among other disorders--neuropsychological effects, migraines, and psychological problems (especially anxiety and depression). Sleep disturbances are also common and have been shown to contribute to the intractability of seizures in some patients. Many anticonvulsant treatments have the potential to improve--or in some cases worsen--these concurrent conditions, and these properties should therefore be considered in the total care of the patient. Finally, the costs of uncontrolled epilepsy are measured not only in terms of direct healthcare-related costs, but also in terms of lost productivity and opportunity. The indirect costs of epilepsy are substantial and account for 70-85% of total disease-related costs. Patients with uncontrolled seizures contribute disproportionately to healthcare costs, reinforcing the need for the development of newer AEDs with improved profiles of efficacy and tolerability, but with minimal adverse effects on behavior, cognition, and sleep.
传统上，癫痫患者的癫痫发作控制被视为最重要的临床结果。然而，目前的抗癫痫药物（AEDs）并不总能达到这一目标。尽管进行了药物干预，但仍有30%-40%的患者癫痫发作得不到控制。AEDs耐受性差是问题的一个重要方面，对治疗的总体有效性的影响与疗效相当。许多患者存在合并症，对这些合并症进行适当管理可进一步改善癫痫发作控制和生活质量。癫痫患者经常会出现——除其他疾病外——神经心理影响、偏头痛和心理问题（尤其是焦虑和抑郁）。睡眠障碍也很常见，并且已证明在某些患者中会导致癫痫发作难以控制。许多抗惊厥治疗有可能改善——或在某些情况下恶化——这些并发疾病，因此在对患者的全面护理中应考虑这些特性。最后，未得到控制的癫痫的成本不仅体现在与医疗保健直接相关的成本方面，还体现在生产力和机会的损失方面。癫痫的间接成本相当可观，占与疾病相关的总成本的70%-85%。癫痫发作未得到控制的患者对医疗保健成本的贡献不成比例，这进一步凸显了开发疗效和耐受性更好、但对行为、认知和睡眠副作用最小的新型AEDs的必要性。
