Abou-Khalil Bassel W
Continuum (Minneap Minn). 2016 Feb;22(1 Epilepsy):132-56. doi: 10.1212/CON.0000000000000289.
Treatment of epilepsy starts with antiepileptic drug (AED) monotherapy. Knowledge of the spectrum of efficacy, clinical pharmacology, and modes of use for individual AEDs is essential for optimal treatment for epilepsy. This article addresses AEDs individually, focusing on key pharmacokinetic characteristics, indications, and modes of use.
Older-generation AEDs are effective but have tolerability and pharmacokinetic disadvantages. Several newer-generation AEDs have undergone comparative trials demonstrating efficacy equal to and tolerability at least equal to or better than older AEDs as first-line therapy. The list includes lamotrigine, oxcarbazepine, levetiracetam, topiramate, and, more recently, zonisamide. Pregabalin was found to be less effective than lamotrigine. Lacosamide, pregabalin, and eslicarbazepine have undergone successful trials of conversion to monotherapy. Other newer-generation AEDs with a variety of mechanisms of action are suitable for adjunctive therapy. Rational AED combinations should avoid AEDs with unfavorable pharmacokinetic interactions or pharmacodynamic interactions related to mechanism of action.
Knowledge of AED pharmacokinetics, efficacy, and tolerability profiles facilitates the choice of appropriate AED therapy for patients with epilepsy.
癫痫治疗始于抗癫痫药物（AED）单药治疗。了解每种AED的疗效范围、临床药理学和使用方式对于癫痫的最佳治疗至关重要。本文分别探讨各种AED，重点关注关键的药代动力学特征、适应证和使用方式。
第一代AED有效，但存在耐受性和药代动力学方面的劣势。几种新一代AED已进行了比较试验，结果表明其作为一线治疗药物的疗效与第一代AED相当，耐受性至少与之相当或更佳。这些药物包括拉莫三嗪、奥卡西平、左乙拉西坦、托吡酯，以及最近的唑尼沙胺。发现普瑞巴林的疗效不如拉莫三嗪。拉科酰胺、普瑞巴林和依斯利卡巴嗪已成功进行了转换为单药治疗的试验。其他具有多种作用机制的新一代AED适用于辅助治疗。合理的AED联合用药应避免使用具有不良药代动力学相互作用或与作用机制相关的药效学相互作用的AED。
了解AED的药代动力学、疗效和耐受性特征有助于为癫痫患者选择合适的AED治疗方案。
