Hitiris Nikolas, Brodie Martin J
Epilepsy Unit, Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow G11 6NT, UK.
Curr Opin Neurol. 2006 Apr;19(2):175-80. doi: 10.1097/01.wco.0000218235.67840.82.
Ten antiepileptic drugs have been licensed since 1990. Their usage will be briefly reviewed focusing on new data and inclusion in guidelines. The hypotheses exploring the underlying basis of pharmacoresistance will be presented.
Lamotrigine, gabapentin, topiramate, and oxcarbazepine are available for use as monotherapy in many countries following comparative studies with older antiepileptic drugs. Zonisamide and pregabalin have recently obtained licences as adjuvant therapy in the US and Europe for partial epilepsy with or without secondary generalization. The UK National Institute for Clinical Excellence guideline has advised, largely based on cost, against the routine use of modern antiepileptic drugs, except when older drugs have failed or are contraindicated. This contrasts with the US guidelines which are less conservative. Surgically resected specimens from patients with refractory epilepsy have led to the development of two hypotheses to explain pharmacoresistant epilepsy.
The introduction of 10 new antiepileptic drugs has provided greater choice for patients and doctors, although evidence in support of their superiority over the older drugs is sparse. This has led to conflicting advice in guidelines. Recent developments in the understanding of pharmacoresistance may explain the relatively high incidence of refractory epilepsy.
自1990年以来，已有10种抗癫痫药物获批上市。本文将简要回顾其使用情况，重点关注新数据以及在指南中的纳入情况。同时将介绍探索药物抵抗潜在机制的假说。
在与传统抗癫痫药物进行对比研究后，拉莫三嗪、加巴喷丁、托吡酯和奥卡西平在许多国家可作为单药治疗使用。唑尼沙胺和普瑞巴林最近在美国和欧洲已获批作为辅助治疗药物，用于治疗伴有或不伴有继发性全面发作的部分性癫痫。英国国家临床优化研究所的指南主要基于成本因素，建议除在传统药物治疗失败或有禁忌证的情况下，不要常规使用现代抗癫痫药物。这与美国指南较为保守的态度形成对比。对难治性癫痫患者手术切除的标本进行研究后，产生了两种假说以解释药物抵抗性癫痫。
10种新型抗癫痫药物的引入为患者和医生提供了更多选择，尽管支持它们优于传统药物的确切证据很少。这导致了指南中的建议相互矛盾。对药物抵抗的最新认识进展可能解释了难治性癫痫相对较高的发病率。
