Galanopoulou Aristea S, Mowrey Wenzhu B
Saul R. Korey Department of Neurology, Dominick P. Purpura Department of Neuroscience, Laboratory of Developmental Epilepsy, Montefiore / Einstein Epilepsy Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx NY USA.
Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx NY USA.
Epilepsia Open. 2016 Dec;1(3-4):86-101. doi: 10.1002/epi4.12021. Epub 2016 Oct 27.
Preclinical studies have produced numerous drugs with antiseizure properties which currently are the standard of care in clinical care. A third of the human population with epilepsy still continues having seizures despite the ongoing discoveries. The recognized clinical gaps of care that need to be addressed are the identification of antiepileptogenic and disease modifying treatments, treatments for refractory seizures or for seizures and epilepsies with limited or unsatisfactory treatments, such as early life epileptic encephalopathies. In this invited review, we provide a historical summary of the international efforts to re-evaluate the strategies adopted in preclinical epilepsy therapy discovery studies. We discuss issues that may impact the quality, interpretation and validation of preclinical studies and their translation to successful therapies for humans affected with epilepsy. These include the selection of animal models and the study design, research practices that affect rigor, such as appropriate use of statistics and reporting of study methods and results, their validation across models, labs and preclinical-clinical studies, the need to harmonize research methods and outcome assessment, and the importance to improve translation to clinically appropriate situations. The epilepsy research community is incrementally adopting collaborative research, including consortia or multicenter studies to meet these needs. Improving the infrastructure that can support these efforts will be instrumental in the future success.
临床前研究已研发出众多具有抗癫痫特性的药物,这些药物目前是临床治疗的标准。尽管不断有新发现,但仍有三分之一的癫痫患者持续发作。目前公认的需要解决的临床护理差距在于确定抗癫痫发生和疾病修饰治疗方法,为难治性癫痫或治疗方法有限或效果不佳的癫痫(如早期生命癫痫性脑病)进行治疗。在这篇特邀综述中,我们对重新评估临床前癫痫治疗发现研究中所采用策略的国际努力进行了历史总结。我们讨论了可能影响临床前研究质量、解读和验证以及将其转化为对癫痫患者成功治疗方法的问题。这些问题包括动物模型的选择和研究设计、影响严谨性的研究实践(如统计学的恰当使用以及研究方法和结果的报告)、在不同模型、实验室以及临床前 - 临床研究中的验证、协调研究方法和结果评估的必要性,以及提高转化到临床适用情况的重要性。癫痫研究界正在逐步采用合作研究,包括联合研究或多中心研究来满足这些需求。改善能够支持这些努力的基础设施将对未来的成功起到重要作用。