van Koert Rick R, Bauer Prisca R, Schuitema Ilse, Sander Josemir W, Visser Gerhard H
Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands.
Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands; NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.
Epilepsy Behav. 2018 Mar;80:37-47. doi: 10.1016/j.yebeh.2017.11.003. Epub 2018 Feb 3.
Caffeine is the most commonly used central nervous system (CNS) stimulant. The relationship between caffeine, seizures, epilepsy, and antiepileptic drugs (AEDs) is complex and not fully understood. Case reports suggest that caffeine triggers seizures in susceptible people. Our systematic review reports on the relationship between caffeine, seizures, and drugs in animal and human studies. Quantitative analyses were also done on animal studies regarding the effects of caffeine on AEDs.
PubMed was searched for studies assessing the effects of caffeine on seizure susceptibility, epilepsy, and drug interactions in people and in animal models. To quantify the interaction between AEDs and caffeine, the data of six animal studies were pooled and analyzed using a general linear model univariate analysis or One-way Analysis of Variance (ANOVA).
In total, 442 items were identified from which we included 105 studies. Caffeine can increase seizure susceptibility and protect from seizures, depending on the dose, administration type (chronic or acute), and the developmental stage at which caffeine exposure started. In animal studies, caffeine decreased the antiepileptic potency of some drugs; this effect was strongest in topiramate.
Preclinical studies suggest that caffeine increases seizure susceptibility. In some cases, chronic use of caffeine may protect against seizures. Caffeine lowers the efficacy of several drugs, especially topiramate. It is unclear how these findings in models can be translated to the clinical condition. Until clinical studies suggest otherwise, caffeine intake should be considered as a factor in achieving and maintaining seizure control in epilepsy.
咖啡因是最常用的中枢神经系统（CNS）兴奋剂。咖啡因、癫痫发作、癫痫和抗癫痫药物（AEDs）之间的关系复杂且尚未完全明确。病例报告表明，咖啡因会在易感人群中引发癫痫发作。我们的系统评价报告了动物和人体研究中咖啡因、癫痫发作及药物之间的关系。还对动物研究中咖啡因对AEDs的影响进行了定量分析。
在PubMed上检索评估咖啡因对人和动物模型中癫痫易感性、癫痫及药物相互作用影响的研究。为量化AEDs与咖啡因之间的相互作用，汇总了六项动物研究的数据，并使用一般线性模型单变量分析或单因素方差分析（ANOVA）进行分析。
总共识别出442项研究，从中纳入了105项研究。咖啡因可增加癫痫易感性，也可预防癫痫发作，这取决于剂量、给药类型（慢性或急性）以及开始接触咖啡因时的发育阶段。在动物研究中，咖啡因降低了某些药物的抗癫痫效力；这种作用在托吡酯中最为明显。
临床前研究表明，咖啡因会增加癫痫易感性。在某些情况下，长期使用咖啡因可能预防癫痫发作。咖啡因会降低几种药物的疗效，尤其是托吡酯。尚不清楚模型中的这些发现如何转化为临床情况。在临床研究表明并非如此之前，应将咖啡因摄入视为癫痫患者实现和维持癫痫控制的一个因素。
