Department of Neurology, Maguire Center, Stritch School of Medicine, Loyola University Chicago, Suite 2700, 2160 South, First Avenue, Maywood, IL 60153, USA.
Neurol Clin. 2010 Nov;28(4):843-52. doi: 10.1016/j.ncl.2010.03.026.
In the past 2 decades, 12 new antiepileptic drugs (AED) have been approved by the Food and Drug Administration for the treatment of epilepsy, making the selection process more complex. When choosing an AED several factors are considered including its relative efficacy, tolerability, serious toxicity, ease of use (determined by the pharmacokinetic profile and the drug-drug interaction potential), the presence of comorbid conditions, and cost. Age and gender are also important considerations. The tradition of recognizing a first-choice drug for a certain seizure type or epilepsy syndrome is no longer a practical concept. With so many AED available, depending on several factors, different patients with a similar type of epilepsy may be prescribed entirely different AED. The newer AED have shown no better efficacy than the classic drugs, but they are easier to use, with much better pharmacokinetic profiles and fewer drug interactions. The list of broad-spectrum drugs has greatly expanded, a major benefit for patients with generalized epilepsies. The long list of available AED has also benefited patients with epilepsy and comorbidities, often allowing for the use of drugs with positive or at least no negative effects on those conditions. Some practical recommendations on the selection of AED are provided in this article.
在过去的 20 年中，有 12 种新的抗癫痫药物（AED）获得了美国食品和药物管理局（FDA）的批准，用于治疗癫痫，这使得选择过程更加复杂。在选择 AED 时，需要考虑多个因素，包括其相对疗效、耐受性、严重毒性、易用性（由药代动力学特征和药物相互作用潜力决定）、共存疾病的存在以及成本。年龄和性别也是重要的考虑因素。传统上认为某种特定类型的癫痫发作或癫痫综合征有首选药物，但这一概念在目前已不再适用。有如此多的 AED 可供选择，根据多种因素，患有类似类型癫痫的不同患者可能会被开完全不同的 AED。新型 AED 与经典药物相比并未显示出更好的疗效，但它们更容易使用，药代动力学特征更好，药物相互作用更少。广谱药物的种类大大增加，这对全身性癫痫患者来说是一大益处。大量的 AED 也使合并症患者受益，通常可以使用对这些疾病有积极影响或至少无负面影响的药物。本文提供了一些关于选择 AED 的实用建议。
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