Department of Anatomy and Neurobiology, University of California, Irvine, California, USA.
Epilepsia. 2009 Jul;50(7):1657-69. doi: 10.1111/j.1528-1167.2009.02173.x. Epub 2009 Jul 1.
There are essentially two potential treatment options for any acquired disorder: symptomatic or prophylactic. For acquired epilepsies that follow a variety of different brain insults, there remains a complete lack of prophylactic treatment options, whereas at the same time these epilepsies are notoriously resistant, once they have emerged, to symptomatic treatments with antiepileptic drugs. The development of prophylactic strategies is logistically challenging, both for basic researchers and clinicians. Nevertheless, cannabinoid-targeting drugs provide a very interesting example of a system within the central nervous system (CNS) that can have very different acute and long-term effects on hyperexcitability and seizures. In this review, we outline research on cannabinoids suggesting that although cannabinoid antagonists are acutely proconvulsant, they may have beneficial effects on long-term hyperexcitability following brain insults of multiple etiologies, making them promising candidates for further investigation as prophylactics against acquired epilepsy. We then discuss some of the implications of this finding on future attempts at prophylactic treatments, specifically, the very short window within which prevention may be possible, the possibility that traditional anticonvulsants may interfere with prophylactic strategies, and the importance of moving beyond anticonvulsants-even to proconvulsants-to find the ideal preventative strategy for acquired epilepsy.
对于任何后天获得的疾病,基本上有两种潜在的治疗选择:对症治疗或预防治疗。对于由多种不同脑损伤引起的后天性癫痫,目前仍然完全缺乏预防治疗选择,而与此同时,这些癫痫一旦出现,用抗癫痫药物进行对症治疗通常效果不佳。对于基础研究人员和临床医生来说,预防策略的制定在后勤上都极具挑战性。尽管如此,大麻素靶向药物为中枢神经系统(CNS)内的一个系统提供了一个非常有趣的例子,该系统对过度兴奋和癫痫可能具有非常不同的急性和长期影响。在这篇综述中,我们概述了有关大麻素的研究,表明尽管大麻素拮抗剂在急性情况下会诱发癫痫发作,但它们可能对多种病因引起的脑损伤后的长期过度兴奋有有益的影响,这使它们成为进一步研究的有希望的候选药物,可作为后天性癫痫的预防药物。然后,我们讨论了这一发现对未来预防治疗尝试的一些影响,具体而言,包括预防可能发生的时间窗口非常短、传统抗癫痫药可能干扰预防策略的可能性,以及超越抗癫痫药——甚至是致癫痫药——寻找后天性癫痫理想预防策略的重要性。