Krauss Gregory L, Sperling Michael R
Johns Hopkins University (GLK), Baltimore; and Thomas Jefferson University (MRS), Philadelphia.
Neurol Clin Pract. 2011 Dec;1(1):14-23. doi: 10.1212/CPJ.0b013e31823d07d1.
Recent evidence suggests that medically resistant epilepsy can be identified if seizures persist despite adequate doses of 2 appropriate first-line antiepileptic drugs (AEDs). Patients with medically resistant epilepsy should have their seizures carefully characterized in order to confirm their diagnosis, select treatment, and assist in determining prognosis. Patients should be counseled about factors that aggravate epilepsy and the importance of adhering to treatments. Physicians should carefully inquire about side effects and alter therapy to eliminate or minimize these symptoms. Uncontrolled seizures cause injuries, disability, and increased mortality, so surgery should be considered as soon as seizures are proven to be medically resistant. Patients with incomplete response to AEDs and who are not surgical candidates may benefit from additional medication trials or from palliative nonmedical therapies, such as vagal nerve stimulation.
近期证据表明，如果在足量使用两种合适的一线抗癫痫药物（AEDs）的情况下癫痫发作仍持续存在，那么就可以识别出药物难治性癫痫。药物难治性癫痫患者应仔细对其癫痫发作进行特征描述，以便确诊、选择治疗方法并协助判断预后。应向患者告知加重癫痫的因素以及坚持治疗的重要性。医生应仔细询问副作用情况，并调整治疗方案以消除或减轻这些症状。未得到控制的癫痫发作会导致受伤、残疾和死亡率增加，因此一旦证实癫痫具有药物难治性，就应考虑手术治疗。对AEDs反应不完全且不适合手术的患者，可能会从额外的药物试验或姑息性非药物治疗（如迷走神经刺激）中获益。
