The Walton Centre for Neurology and Neurosurgery NHS Foundation Trust , Liverpool , UK
Expert Opin Pharmacother. 2014 Aug;15(11):1543-51. doi: 10.1517/14656566.2014.922544. Epub 2014 May 26.
Epilepsy is the most common neurological condition worldwide with significant psychosocial and physical morbidity. Its management requires expertise and good pharmacological knowledge of the available options.
This review covers the management of focal epilepsy addressing the common questions arising through the patients' journey, including timing of starting initial treatment, monotherapy options, add-on treatment for refractory cases and withdrawal of medication during remission.
Initiating anti-epileptic drug (AED) treatment requires assessment of patient preferences and of evidence of benefit and harm. Evidence of benefit will come primarily from randomised controlled trials, although in epilepsy, most trials are undertaken to inform regulatory decision and have important limitations for informing clinical decisions. Evidence about harm may come not only from randomised trials but also from other sources. Most patients will start treatment following a second focal seizure. Carbamazepine and lamotrigine are good initial monotherapy options. Newer AEDs have proof of efficacy as monotherapy but evidence is insufficient to recommend them as first-line treatments. For refractory cases, there are an increasing number of AEDs available, but evidence of efficacy is primarily from placebo-controlled trials, and there is no robust evidence to inform a choice among treatments.
癫痫是全球最常见的神经系统疾病，具有显著的社会心理和身体发病率。其治疗需要专业知识和对现有治疗选择的良好药理学知识。
本篇综述涵盖了局灶性癫痫的治疗，解决了患者治疗过程中常见的问题，包括初始治疗的起始时间、单药治疗选择、难治性病例的附加治疗以及缓解期药物停药。
启动抗癫痫药物（AED）治疗需要评估患者的偏好以及获益和危害的证据。获益证据主要来自随机对照试验，尽管在癫痫中，大多数试验都是为了为监管决策提供信息，并且对临床决策的信息有重要限制。危害证据不仅可能来自随机试验，也可能来自其他来源。大多数患者在第二次局灶性发作后开始治疗。卡马西平和拉莫三嗪是很好的初始单药治疗选择。新的 AED 具有作为单药治疗的疗效证据，但证据不足以推荐它们作为一线治疗。对于难治性病例，有越来越多的 AED 可供选择，但疗效证据主要来自安慰剂对照试验，没有有力的证据可以在治疗之间做出选择。
