Crepeau Amy Z, Sirven Joseph I
Department of Neurology, Mayo Clinic, Phoenix, AZ.
Department of Neurology, Mayo Clinic, Phoenix, AZ.
Mayo Clin Proc. 2017 Feb;92(2):306-318. doi: 10.1016/j.mayocp.2016.11.013.
Epilepsy is a common yet heterogeneous disease. As a result, management often requires complex decision making. The ultimate goal of seizure management is for the patient to have no seizures and no considerable adverse effects from the treatment. Antiepileptic drugs are the mainstay of therapy, with more than 20 medications currently approved in the United States. Antiepileptic drug selection requires an understanding of the patient's epilepsy, along with consideration of comorbidities and potential for adverse events. After a patient has failed at least 2 appropriate antiepileptic drugs, they are determined to be medically refractory. At this time, additional therapy, including dietary, device, or surgical treatments, need to be considered, typically at a certified epilepsy center. All these treatments require consideration of the potential for seizure freedom, balanced against potential adverse effects, and can have a positive effect on seizure control and quality of life. This review article discussed the treatment options available for adults with epilepsy, including medical, surgical, dietary, and device therapies.
癫痫是一种常见但异质性的疾病。因此，治疗往往需要复杂的决策。癫痫发作管理的最终目标是让患者无癫痫发作且治疗无明显不良反应。抗癫痫药物是治疗的主要手段，目前美国有20多种药物获批。抗癫痫药物的选择需要了解患者的癫痫情况，同时考虑合并症和不良事件的可能性。当患者至少两种合适的抗癫痫药物治疗失败后，他们被判定为药物难治性癫痫。此时，需要考虑其他治疗方法，包括饮食、器械或手术治疗，通常要在认证的癫痫中心进行。所有这些治疗都需要考虑实现无癫痫发作的可能性，并权衡潜在的不良反应，而且对癫痫控制和生活质量会有积极影响。这篇综述文章讨论了成人癫痫的可用治疗方案，包括药物、手术、饮食和器械治疗。
