Institute of Medical and Biomedical Education, St George's University of London and Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust , London, UK.
Expert Opin Pharmacother. 2021 Feb;22(3):317-323. doi: 10.1080/14656566.2020.1829594. Epub 2020 Oct 15.
Focal seizures represent the most common seizure type and focal epilepsies the most common epilepsy type. Anti-seizure medications (ASMs) still represent the main form of treatment for epilepsy.
The aim of this review article is to provide an overview of available evidence about current and upcoming pharmacological options and strategies for adults with focal epilepsy focusing on the last 5 years.
Seventeen drugs are currently approved for the treatment of focal seizures including cenobamate as the very latest option. Ten of these drugs are also licensed for monotherapy. Level A evidence for initial monotherapy is available for seven drugs with no robust data supporting that one drug is superior to the other. Safety, tolerability as well as pharmacoeconomic reasons would then drive treatment decisions. Data on adjunctive treatment are available for 13 ASMs showing again no obvious difference in terms of efficacy. Evidence on specific drug combinations is almost non-existent and the final decision of combining specific drugs is based on the experience of the individual clinician rather than on robust evidence. Current outcome measures do not consider number of previously failed drugs and the observation period is often too short.
局灶性发作是最常见的癫痫发作类型，局灶性癫痫是最常见的癫痫类型。抗癫痫药物（ASM）仍然是治疗癫痫的主要形式。
本文旨在提供有关当前和即将出现的药理学选择和策略的最新证据概述，重点关注过去 5 年成人局灶性癫痫。
目前有 17 种药物被批准用于治疗局灶性发作，包括最近的 Cenobamate。其中十种药物也可用于单药治疗。七种药物的初始单药治疗有 A 级证据，但没有确凿数据表明一种药物优于另一种药物。安全性、耐受性以及药物经济学因素将决定治疗决策。有 13 种 ASM 的辅助治疗数据，其疗效也没有明显差异。关于特定药物联合治疗的数据几乎不存在，最终选择联合使用特定药物是基于个别临床医生的经验，而不是基于确凿的证据。目前的疗效评估指标不考虑之前失败药物的数量，观察期往往太短。
