French Jacqueline A, Gazzola Deana M
Continuum (Minneap Minn). 2013 Jun;19(3 Epilepsy):643-55. doi: 10.1212/01.CON.0000431380.21685.75.
Selection of the ideal antiepileptic drug (AED) for an individual patient can be a daunting process. Choice of treatment should be based on several factors, including but not limited to epilepsy classification, AED mechanism of action, AED side-effect profile, and drug interactions. Special consideration must be given to populations such as women, older adults, patients with other medical comorbidities, and patients who are newly diagnosed.
Head-to-head trials between AEDs in newly diagnosed patients rarely demonstrate that one AED is more or less effective. The second-generation drugs, lamotrigine, topiramate, oxcarbazepine, zonisamide, and levetiracetam, have undergone head-to-head trials confirming similar efficacy and equal or better tolerability than standard drugs in focal epilepsy.
A thoughtful approach to the AED selection process must factor in data from clinical AED trials as well as a variety of patient characteristics and confounding factors. When neurologists apply an individualized approach to AED drug selection for their patients, they can find an effective and well-tolerated drug for most patients.
为个体患者选择理想的抗癫痫药物（AED）可能是一个艰巨的过程。治疗选择应基于多个因素，包括但不限于癫痫分类、AED作用机制、AED副作用概况以及药物相互作用。对于女性、老年人、患有其他合并症的患者以及新诊断的患者等人群，必须给予特殊考虑。
新诊断患者中AED之间的头对头试验很少表明一种AED的疗效更高或更低。第二代药物，拉莫三嗪、托吡酯、奥卡西平、唑尼沙胺和左乙拉西坦，已经进行了头对头试验，证实了在局灶性癫痫中具有相似的疗效，并且耐受性与标准药物相当或更好。
在AED选择过程中，一种周全的方法必须考虑来自临床AED试验的数据以及各种患者特征和混杂因素。当神经科医生为患者采用个性化的AED药物选择方法时，他们可以为大多数患者找到一种有效且耐受性良好的药物。
