Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
Epilepsia. 2011 May;52 Suppl 3:40-4. doi: 10.1111/j.1528-1167.2011.03035.x.
Data on the effects of antiepileptic drugs on the immune system are frequently inconsistent and sometimes conflicting because the effects of drugs cannot be separated from those of seizures, first-generation drugs have been most intensively investigated, the patient's genetic background, the mechanism of action and the pharmacokinetic profile of AEDs and the concurrent use of immunosuppressant drugs may act as confounders. Valproate, carbamazepine, phenytoin, vigabatrin, levetiracetam, and diazepam have been found to modulate the immune system activity by affecting humoral and cellular immunity. AEDs are associated with pharmacokinetic interactions (most frequently occurring with carbamazepine, phenytoin, phenobarbital and valproate). Hepatic metabolism is the primary site of interaction for both AEDs and immunotherapies (ACTH, dexamethasone, hydrocortisone, methylprednisolone, cyclophosphamide, methotrexate, rituximab), which entail induction or inhibition of drug effects. However, the clinical importance of these drug interactions is still far from defined. An important adverse effect of the action of AEDs on the immune system is antiepileptic hypersensitivity syndrome (AHS), a life-threatening, idiosyncratic cutaneous reaction to aromatic AEDs resulting in end organ damage. Phenytoin, carbamazepine, phenobarbital, lamotrigine, oxcarbazepine, felbamate, and zonisamide have been implicated. The pathogenic mechanisms of AHS are incompletely understood.
抗癫痫药物对免疫系统影响的数据常常不一致，有时甚至相互矛盾，这是因为药物的影响不能与癫痫发作的影响分开，第一代药物已被最深入地研究，患者的遗传背景、抗癫痫药物的作用机制和药代动力学特征以及同时使用免疫抑制剂可能作为混杂因素。丙戊酸、卡马西平、苯妥英钠、氨己烯酸、左乙拉西坦和地西泮已被发现通过影响体液和细胞免疫来调节免疫系统活性。抗癫痫药物与药代动力学相互作用有关（最常与卡马西平、苯妥英钠、苯巴比妥和丙戊酸发生）。肝代谢是抗癫痫药物和免疫疗法（ACTH、地塞米松、氢化可的松、甲泼尼龙、环磷酰胺、甲氨蝶呤、利妥昔单抗）相互作用的主要部位，这需要诱导或抑制药物作用。然而，这些药物相互作用的临床重要性仍远未确定。抗癫痫药物对免疫系统作用的一个重要不良影响是抗癫痫药物过敏综合征（AHS），这是一种芳香族抗癫痫药物引起的危及生命的特发性皮肤反应，导致终末器官损伤。已涉及苯妥英钠、卡马西平、苯巴比妥、拉莫三嗪、奥卡西平、托吡酯、氨己烯酸和佐米曲普坦。AHS 的发病机制尚不完全清楚。
