Division of Neurology, Barrow Neurological Institute, St. Joseph's Hospital, and Medical Center Phoenix and Arizona State University, Tempe, Arizona, USA.
Neuropsychiatr Dis Treat. 2010 Jun 24;6:297-308. doi: 10.2147/ndt.s4489.
Diagnosis of complex partial epilepsy is based on the clinical history, and laboratory tests, including EEG and neuroimaging studies, corroborate the diagnosis. The goal of epilepsy management is to make the patient completely seizure-free without drug-induced side effects, even in the patient with refractory complex partial seizures. Frequently this can be accomplished by choice of the optimal antiepileptic drug (AED) or a combination of drugs, the use of strategies to maximize the effectiveness of drug treatment, or by surgical removal of the seizure focus. Currently there are five "classical" first-line AEDs and 11 new AEDs available in the US and in many other countries for the treatment of localization-related epilepsy. The current state of the evidence is that no AED is clearly superior to other AEDs in the management of refractory complex partial seizures. Therefore the choice of which drug to use in an individual patient has to be based on other considerations, including the potential adverse reactions that may occur in that patient. There are a number of strategies for optimal use of AEDs in the management of refractory complex partial seizures. These include verification of the diagnosis of epilepsy and classification of specific seizure types, use of monotherapy if possible but polytherapy if necessary, starting with a low dose and raising it slowly but, until complete seizure control is achieved, pushing to the maximum tolerated dose, changing timing of dosing to reduce toxicity, using pharmacokinetic principles to fine-tune AED doses, adjusting dose for drug-drug interactions, and never giving up in the pursuit of better seizure control. Resection of the seizure focus can be curative in the majority of patients with seizures localized to one mesial temporal lobe. Success rates for resection of extratemporal seizure foci are lower. Vagus nerve stimulation (VNS) devices result in a significant reduction of seizure frequency in many patients, but patients rarely become completely seizure-free as a result of VNS device implantation. Management of refractory complex partial seizures continues to improve with the identification of new drugs and the development of new approaches to their control and cure.
复杂部分性癫痫的诊断基于临床病史，实验室检查，包括脑电图和神经影像学研究，可证实诊断。癫痫管理的目标是使患者无癫痫发作且无药物引起的副作用，即使在难治性复杂部分性癫痫患者中也是如此。通常，通过选择最佳的抗癫痫药物（AED）或药物组合、采用最大限度提高药物治疗效果的策略，或者通过手术切除癫痫灶，可以实现这一目标。目前，美国和许多其他国家有 5 种“经典”一线 AED 和 11 种新型 AED 可用于治疗与定位相关的癫痫。目前的证据表明，在管理难治性复杂部分性癫痫方面，没有一种 AED 明显优于其他 AED。因此，在选择个体患者使用哪种药物时，必须考虑其他因素，包括该患者可能出现的潜在不良反应。有许多策略可用于优化难治性复杂部分性癫痫的 AED 治疗。这些策略包括验证癫痫诊断和特定癫痫类型的分类、如果可能使用单药治疗，但必要时使用多药治疗、从低剂量开始并缓慢增加，但在达到完全癫痫控制之前，要尽可能提高至最大耐受剂量、改变给药时间以减少毒性、利用药代动力学原则微调 AED 剂量、调整剂量以应对药物相互作用，并且在追求更好的癫痫控制时永不放弃。对于癫痫局限于一侧内侧颞叶的大多数患者，切除癫痫灶可达到治愈效果。切除非内侧颞叶癫痫灶的成功率较低。迷走神经刺激（VNS）装置可使许多患者的癫痫发作频率显著降低，但很少有患者因植入 VNS 装置而完全无癫痫发作。随着新药物的发现和控制及治愈新方法的发展，难治性复杂部分性癫痫的治疗不断得到改善。
