Willmore L James
Department of Neurology, Saint Louis University School of Medicine, St. Louis, MO, USA.
Epilepsy Behav. 2005 Dec;7 Suppl 3:S25-8. doi: 10.1016/j.yebeh.2005.08.006. Epub 2005 Oct 18.
There has been a growing interest in the use of antiepileptic drugs (AEDs) for neuroprotection, and in the possible role of AEDs in disease modification (i.e., antiepileptogenesis). Increased understanding of the mechanisms underlying brain injury has led to advances in the study of neuroprotection. However, defining the clinical paradigm and selecting appropriate outcomes to detect neuroprotective effects present challenges to clinicians studying the neuroprotective properties of drugs. Established AEDs, such as phenytoin, phenobarbital, and carbamazepine, have shown neuroprotective activity in an ischemic/hypoxic model of neuronal injury. Animal model studies also have suggested that newer AEDs, such as levetiracetam, topiramate, and zonisamide, may have neuroprotective or antiepileptogenic properties. However, the prevention of epileptogenesis by an AED has yet to be demonstrated in clinical trials. The future of neuroprotection may involve established and newer AEDs, as well as other compounds, such as immunophilins, caspase inhibitors, endocannabinoids, and antioxidants.
人们越来越关注使用抗癫痫药物（AEDs）进行神经保护，以及AEDs在疾病修饰（即抗癫痫发生）中的可能作用。对脑损伤潜在机制的深入了解推动了神经保护研究的进展。然而，确定临床范式并选择合适的结果来检测神经保护作用，对研究药物神经保护特性的临床医生来说是一项挑战。已有的AEDs，如苯妥英、苯巴比妥和卡马西平，在神经元损伤的缺血/缺氧模型中显示出神经保护活性。动物模型研究也表明，新型AEDs，如左乙拉西坦、托吡酯和唑尼沙胺，可能具有神经保护或抗癫痫发生的特性。然而，AEDs预防癫痫发生尚未在临床试验中得到证实。神经保护的未来可能涉及已有的和新型的AEDs，以及其他化合物，如免疫亲和素、半胱天冬酶抑制剂、内源性大麻素和抗氧化剂。
