University of Liverpool, Liverpool, UK
Ther Adv Neurol Disord. 2009 May;2(3):181-7. doi: 10.1177/1756285609102327.
The great majority of randomised controlled trials (RCTs) that compare antiepileptic drugs are industry sponsored and have the objective of obtaining a monotherapy license for a drug. Such trials do not inform everyday clinical practice as they tend to be too short and to depart from clinical practice by restricting clinicians in their choice of actions. The data that exists provides evidence that drugs with actions on voltage-gated sodium channels provide best seizure control for localised onset seizures and epilepsy syndromes, while valproate provides best seizure control for generalised epilepsy and unclassified syndromes. Drugs do, however, vary in their tolerability over the short term and in their risk for rare serious idiosyncratic adverse events, chronic toxicity and teratogenicity; issues that cannot be examined within the scope of RCTs.
绝大多数比较抗癫痫药物的随机对照试验（RCT）都是由工业界赞助的，其目的是为一种药物获得单一疗法的许可。由于此类试验通常时间过短，并且通过限制临床医生的行动选择来脱离临床实践，因此它们并不能为日常临床实践提供信息。现有的数据表明，作用于电压门控钠离子通道的药物为局灶性发作性癫痫和癫痫综合征提供了最佳的癫痫控制，而丙戊酸为全面性癫痫和未分类综合征提供了最佳的癫痫控制。然而，药物在短期内的耐受性和罕见严重的特发性不良反应、慢性毒性和致畸性方面存在差异；这些问题无法在 RCT 范围内进行检查。
