Laxer Kenneth D, Trinka Eugen, Hirsch Lawrence J, Cendes Fernando, Langfitt John, Delanty Norman, Resnick Trevor, Benbadis Selim R
Sutter Pacific Epilepsy Program, California Pacific Medical Center, San Francisco, CA, USA.
Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neuroscience, Salzburg, Austria.
Epilepsy Behav. 2014 Aug;37:59-70. doi: 10.1016/j.yebeh.2014.05.031. Epub 2014 Jun 27.
Seizures in some 30% to 40% of patients with epilepsy fail to respond to antiepileptic drugs or other treatments. While much has been made of the risks of new drug therapies, not enough attention has been given to the risks of uncontrolled and progressive epilepsy. This critical review summarizes known risks associated with refractory epilepsy, provides practical clinical recommendations, and indicates areas for future research. Eight international epilepsy experts from Europe, the United States, and South America met on May 4, 2013, to present, review, and discuss relevant concepts, data, and literature on the consequences of refractory epilepsy. While patients with refractory epilepsy represent the minority of the population with epilepsy, they require the overwhelming majority of time, effort, and focus from treating physicians. They also represent the greatest economic and psychosocial burdens. Diagnostic procedures and medical/surgical treatments are not without risks. Overlooked, however, is that these risks are usually smaller than the risks of long-term, uncontrolled seizures. Refractory epilepsy may be progressive, carrying risks of structural damage to the brain and nervous system, comorbidities (osteoporosis, fractures), and increased mortality (from suicide, accidents, sudden unexpected death in epilepsy, pneumonia, vascular disease), as well as psychological (depression, anxiety), educational, social (stigma, driving), and vocational consequences. Adding to this burden is neuropsychiatric impairment caused by underlying epileptogenic processes ("essential comorbidities"), which appears to be independent of the effects of ongoing seizures themselves. Tolerating persistent seizures or chronic medicinal adverse effects has risks and consequences that often outweigh risks of seemingly "more aggressive" treatments. Future research should focus not only on controlling seizures but also on preventing these consequences.
约30%至40%的癫痫患者的癫痫发作对抗癫痫药物或其他治疗无反应。虽然人们对新药疗法的风险已有诸多关注，但对未得到控制且呈进行性发展的癫痫的风险却关注不足。这篇批判性综述总结了与难治性癫痫相关的已知风险，提供了实用的临床建议，并指出了未来的研究方向。来自欧洲、美国和南美洲的八位国际癫痫专家于2013年5月4日会面，介绍、审查并讨论了有关难治性癫痫后果的相关概念、数据和文献。虽然难治性癫痫患者在癫痫患者群体中占少数，但他们需要治疗医生投入绝大多数的时间、精力和关注。他们还带来了最大的经济和社会心理负担。诊断程序以及药物/手术治疗并非没有风险。然而，被忽视的是，这些风险通常小于长期未得到控制的癫痫发作的风险。难治性癫痫可能会呈进行性发展，带来大脑和神经系统结构损伤、合并症（骨质疏松症、骨折）以及死亡率增加（因自杀、事故、癫痫猝死、肺炎、血管疾病）的风险，还有心理（抑郁、焦虑）、教育、社会（耻辱感、驾驶）和职业方面的后果。由潜在致痫过程导致的神经精神损害（“本质合并症”）进一步加重了这一负担，这种损害似乎独立于持续癫痫发作本身的影响。容忍持续性癫痫发作或慢性药物不良反应所带来的风险和后果往往超过看似“更积极”治疗的风险。未来的研究不仅应专注于控制癫痫发作，还应致力于预防这些后果。
