Mayo Clinic, Rochester, Minnesota, USA.
Curr Neuropharmacol. 2009 Jun;7(2):96-105. doi: 10.2174/157015909788848929.
While several newer AEDs have study data that support monotherapy usage, most possess FDA indications for adjunctive treatment of partial onset seizures, leading to their initial (and often persistent) clinical use as adjunctive polytherapy for patients with refractory epilepsy. This review considers a practical approach to the appropriate role for polytherapy in epilepsy, presents the evidence for AED polytherapy, reviews the mythic but practically reasonable concept of "rational polytherapy," and concludes with practical strategies for avoiding and employing polytherapy in clinical practice. The appropriate indications for AED polytherapy include transitional polytherapy during titration of a new adjunctive AED toward monotherapy or long-term maintenance AED polytherapy in medically refractory epilepsy.
虽然有几种较新的 AED 具有支持单药治疗使用的数据，但大多数都具有 FDA 用于附加治疗部分发作性癫痫的适应症，导致它们最初（且通常持续）作为难治性癫痫患者的附加联合治疗药物而被临床使用。本篇综述考虑了一种合理的方法来确定联合治疗在癫痫中的适当作用，介绍了 AED 联合治疗的证据，回顾了“合理的联合治疗”这一虚构但实际合理的概念，并总结了在临床实践中避免和采用联合治疗的实用策略。AED 联合治疗的适当适应症包括在滴定新的附加 AED 以实现单药治疗或在药物难治性癫痫中进行长期维持 AED 联合治疗期间的过渡性联合治疗。
