Reynolds E H
University Department of Neurology, Institute of Psychiatry and Kings College Hospital Medical School, London, England.
Epilepsia. 1987;28 Suppl 3:S77-80. doi: 10.1111/j.1528-1157.1987.tb05782.x.
Despite the widespread and traditional use of polytherapy in the treatment of epilepsy, there is little evidence of its advantages over monotherapy. Among other undesirable effects, it can produce subtle cognitive and behavioral changes and sometimes even exacerbate the epilepsy. Recent studies provide evidence that in many patients seizures can be controlled by carefully monitored monotherapy: Approximately 75% of newly diagnosed, previously untreated epileptic patients will enter a 2-year remission with this form of treatment. The theory has even been advanced that early control of seizures may help prevent the evolution of drug-resistant, chronic epilepsy. In some patients with chronic epilepsy, multiple-drug therapy can be reduced to single-drug treatment, usually with an improvement in cognitive function and without increase in seizures. Trials conducted to date have shown no evidence of superiority of any one major antiepileptic drug over another in control of a particular seizure type. The choice of antiepileptic drug for monotherapy may therefore be influenced by differences in toxic effects associated with individual agents. On the basis of clinical and psychometric evidence, carbamazepine has been shown to cause fewer adverse effects than other antiepileptic drugs on cognitive function, mood, and behavior.
尽管联合治疗在癫痫治疗中被广泛且传统地使用，但几乎没有证据表明它比单一疗法更具优势。在其他不良影响中，它会产生细微的认知和行为变化，有时甚至会加重癫痫病情。最近的研究表明，在许多患者中，通过仔细监测单一疗法可以控制癫痫发作：大约75%新诊断的、以前未接受治疗的癫痫患者通过这种治疗形式将进入两年缓解期。甚至有人提出理论，早期控制癫痫发作可能有助于预防耐药性慢性癫痫的发展。在一些慢性癫痫患者中，多药治疗可以减为单药治疗，通常认知功能会有所改善且癫痫发作不会增加。迄今为止进行的试验表明，在控制特定癫痫发作类型方面，没有证据表明任何一种主要抗癫痫药物优于另一种。因此，单一疗法中抗癫痫药物的选择可能会受到与个别药物相关的毒性作用差异的影响。根据临床和心理测量证据，已表明卡马西平在认知功能、情绪和行为方面比其他抗癫痫药物引起的不良反应更少。
