Maguire Melissa, Marson Anthony G, Ramaratnam Sridharan
Newcastle General Hospital, Newcastle-upon-Tyne, UK.
BMJ Clin Evid. 2010 Jun 28;2010:1214.
About 3% of people will be diagnosed with epilepsy during their lifetime, but about 70% of people with epilepsy eventually go into remission.
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of starting antiepileptic drug treatment following a single seizure? What are the effects of drug monotherapy in people with partial epilepsy? What are the effects of additional drug treatments in people with drug-resistant partial epilepsy? What is the risk of relapse in people in remission when withdrawing antiepileptic drugs? What are the effects of behavioural and psychological treatments for people with epilepsy? What are the effects of surgery in people with drug-resistant temporal lobe epilepsy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 83 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: antiepileptic drugs after a single seizure; monotherapy for partial epilepsy using carbamazepine, gabapentin, lamotrigine, levetiracetam, phenobarbital, phenytoin, sodium valproate, or topiramate; addition of second-line drugs for drug-resistant partial epilepsy (allopurinol, eslicarbazepine, gabapentin, lacosamide, lamotrigine, levetiracetam, losigamone, oxcarbazepine, retigabine, tiagabine, topiramate, vigabatrin, or zonisamide); antiepileptic drug withdrawal for people with partial or generalised epilepsy who are in remission; behavioural and psychological treatments for partial or generalised epilepsy (biofeedback, cognitive behavioural therapy (CBT), educational programmes, family counselling, relaxation therapy (alone or plus behavioural modification therapy, yoga); and surgery for drug-resistant temporal lobe epilepsy ( lesionectomy, temporal lobectomy, vagus nerve stimulation as adjunctive therapy).
约3%的人在其一生中会被诊断为癫痫，但约70%的癫痫患者最终会进入缓解期。
我们进行了一项系统评价，旨在回答以下临床问题：单次发作后开始抗癫痫药物治疗的效果如何？部分性癫痫患者药物单药治疗的效果如何？耐药性部分性癫痫患者额外药物治疗的效果如何？癫痫缓解期患者停用抗癫痫药物后的复发风险如何？癫痫患者行为和心理治疗的效果如何？耐药性颞叶癫痫患者手术治疗的效果如何？我们检索了：截至2009年7月的Medline、Embase、Cochrane图书馆及其他重要数据库（Clinical Evidence综述会定期更新；请查看我们的网站获取本综述的最新版本）。我们纳入了来自美国食品药品监督管理局（FDA）和英国药品及保健品监管局（MHRA）等相关组织的危害警示。
我们发现83项系统评价、随机对照试验或观察性研究符合我们的纳入标准。我们对干预措施的证据质量进行了GRADE评估。
在本系统评价中，我们呈现了以下干预措施有效性和安全性的相关信息：单次发作后使用抗癫痫药物；使用卡马西平、加巴喷丁、拉莫三嗪、左乙拉西坦、苯巴比妥、苯妥英、丙戊酸钠或托吡酯进行部分性癫痫的单药治疗；为耐药性部分性癫痫添加二线药物（别嘌醇、依斯利卡西平、加巴喷丁、拉科酰胺、拉莫三嗪、左乙拉西坦、洛西加莫、奥卡西平、瑞替加滨、替加宾、托吡酯、氨己烯酸或唑尼沙胺）；部分性或全身性癫痫缓解期患者停用抗癫痫药物；针对部分性或全身性癫痫的行为和心理治疗（生物反馈、认知行为疗法（CBT）、教育项目、家庭咨询、放松疗法（单独或加行为矫正疗法、瑜伽））；以及针对耐药性颞叶癫痫的手术治疗（病灶切除术、颞叶切除术、迷走神经刺激作为辅助治疗）。
Zotero 插件