Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada,
Drugs. 2014 Oct;74(15):1747-55. doi: 10.1007/s40265-014-0293-6.
Antiepileptic drugs (AEDs) are a class of medications that have received considerable attention as possible treatments for agitation and aggression in patients with dementia. This attention has been driven in equal measure by promising findings from limited trial and observational data and the desire to find treatments with improved tolerability. Their use, to date, has been largely confined to circumstances where first-line treatments have proven inadequate or are poorly tolerated. In recent years there has been some growth in the evidence base, and we can now make more informed recommendations regarding a number of older AEDs. Carbamazepine continues to have the best evidence to support its use, although the evidence base remains relatively small and concerns regarding tolerability limit its use. There is now more consistent evidence that valproate preparations should not be used for agitation and aggression in dementia. Despite a lack of high-quality data, some results have been reported for several newer medications, including levetiracetam, oxcarbazepine, gabapentin, topiramate and lamotrigine, and a number of these warrant further investigation. Recent findings and implications for clinical practice are discussed.
抗癫痫药物 (AEDs) 作为治疗痴呆患者激越和攻击行为的可能方法，已引起广泛关注。这一关注既源于有限的试验和观察数据中很有前景的发现，也源于寻找耐受性更好的治疗方法的愿望。迄今为止，它们的使用主要限于一线治疗方法已被证明无效或不能耐受的情况。近年来，证据基础有所增加，我们现在可以就许多较老的 AED 做出更明智的建议。卡马西平仍然具有支持其使用的最佳证据，尽管证据基础仍然相对较小，且对耐受性的担忧限制了其使用。现在有更一致的证据表明，丙戊酸盐制剂不应用于痴呆患者的激越和攻击。尽管缺乏高质量的数据，但已经报道了几种新药物的一些结果，包括左乙拉西坦、奥卡西平、加巴喷丁、托吡酯和拉莫三嗪，其中许多值得进一步研究。讨论了最新发现及其对临床实践的影响。
