Servicio de Neurologa, Unidad de Epilepsia, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
CNS Drugs. 2011 Dec 5;25 Suppl 1:3-16. doi: 10.2165/1159572-S0-000000000-00000.
Epilepsy is one of the most common serious neurological conditions worldwide, with an age-adjusted incidence of approximately 50 per 100,000 persons per year in developed countries. Antiepileptic therapy can result in long-term remission in 60-70% of patients, but many patients will require combination treatment to achieve optimal seizure control, as monotherapy is ineffective at controlling seizures in 30-53% of patients. Despite the increase in available treatment options, patient outcomes have not improved significantly and there is still a need for more effective therapies. Drugs used in the treatment of focal-onset seizures are a diverse range of compounds, and in most cases their mechanism of action is unknown or poorly defined. This review discusses the efficacy and safety of the newer adjuvant antiepileptic therapies that may improve outcomes in patients unresponsive to monotherapy, including clobazam, vigabatrin, lamotrigine, gabapentin, topiramate, tiagabine, levetiracetam, oxcarbazepine, pregabalin, zonisamide and eslicarbazepine, with focus on lacosamide. Lacosamide has been shown to exert its anticonvulsant effects predominantly by enhancement of the slow inactivation of voltage-gated sodium channels. Lacosamide is indicated for use as adjuvant treatment of focal-onset seizures in patients with epilepsy, and there is some evidence that it may also be of use in patients with status epilepticus and cancer patients with epilepsy. The efficacy of lacosamide has been assessed in three randomized, double-blind, placebo-controlled clinical trials, all of which have shown lacosamide to be effective at reducing seizure frequency and increasing 50% responder rates in patients with focal-onset seizures. Long-term lacosamide treatment is generally well tolerated and is not associated with significant drug interactions; the availability of an intravenous form of the drug also makes it particularly useful for a broad range of patients.
癫痫是全球最常见的严重神经系统疾病之一，在发达国家，年龄调整后的发病率约为每 10 万人每年 50 例左右。抗癫痫治疗可以使 60-70%的患者长期缓解，但许多患者需要联合治疗以达到最佳的癫痫控制效果，因为单药治疗在 30-53%的患者中无法有效控制癫痫发作。尽管可用的治疗选择有所增加，但患者的治疗效果并未显著改善，仍然需要更有效的治疗方法。用于治疗局灶性发作的药物是多种化合物，在大多数情况下，其作用机制未知或定义不明确。本综述讨论了新的辅助抗癫痫治疗方法的疗效和安全性，这些方法可能会改善对单药治疗反应不佳的患者的治疗效果，包括氯巴占、氨己烯酸、拉莫三嗪、加巴喷丁、托吡酯、噻加宾、左乙拉西坦、奥卡西平、普瑞巴林、唑尼沙胺和依沙佐双酰胺，重点讨论了拉科酰胺。拉科酰胺主要通过增强电压门控钠离子通道的缓慢失活来发挥其抗惊厥作用。拉科酰胺适用于癫痫患者局灶性发作的辅助治疗，有一些证据表明它也可能对癫痫持续状态患者和癌症合并癫痫患者有用。三项随机、双盲、安慰剂对照临床试验评估了拉科酰胺的疗效，所有试验均表明拉科酰胺可有效减少局灶性发作患者的癫痫发作频率和提高 50%应答率。长期拉科酰胺治疗通常耐受性良好，且与显著的药物相互作用无关；该药物还具有静脉制剂，这使其特别适用于广泛的患者群体。
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