Ekstein Dana, Noyman Iris, Fahoum Firas, Herskovitz Moshe, Linder Ilan, Ben Zeev Bruria, Eyal Sara
Department of Neurology, Ginges Center of Human Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Pediatric Neurology Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Isr Med Assoc J. 2020 Nov;11(22):665-672.
The coronavirus disease-2019 (COVID-19) and its management in patients with epilepsy can be complex. Prescribers should consider potential effects of investigational anti-COVID-19 drugs on seizures, immunomodulation by anti-seizure medications (ASMs), changes in ASM pharmacokinetics, and the potential for drug-drug interactions (DDIs). The goal of the Board of the Israeli League Against Epilepsy (the Israeli Chapter of the International League Against Epilepsy, ILAE) was to summarize the main principles of the pharmacological treatment of COVID-19 in patients with epilepsy. This guide was based on current literature, drug labels, and drug interaction resources. We summarized the available data related to the potential implications of anti-COVID-19 co-medication in patients treated with ASMs. Our recommendations refer to drug selection, dosing, and patient monitoring. Given the limited availability of data, some recommendations are based on general pharmacokinetic or pharmacodynamic principles and might apply to additional future drug combinations as novel treatments emerge. They do not replace evidence-based guidelines, should those become available. Awareness to drug characteristics that increase the risk of interactions can help adjust anti-COVID-19 and ASM treatment for patients with epilepsy.
2019冠状病毒病（COVID-19）及其在癫痫患者中的管理可能很复杂。开处方者应考虑研究性抗COVID-19药物对癫痫发作的潜在影响、抗癫痫药物（ASM）的免疫调节作用、ASM药代动力学的变化以及药物相互作用（DDI）的可能性。以色列癫痫联盟委员会（国际抗癫痫联盟以色列分会，ILAE）的目标是总结癫痫患者COVID-19药物治疗的主要原则。本指南基于当前文献、药品标签和药物相互作用资源。我们总结了与抗COVID-19联合用药对接受ASM治疗患者的潜在影响相关的现有数据。我们的建议涉及药物选择、给药剂量和患者监测。鉴于数据有限，一些建议基于一般药代动力学或药效学原则，可能适用于未来随着新治疗方法出现的其他药物组合。如果有循证指南，这些建议不能替代它们。了解增加相互作用风险的药物特性有助于为癫痫患者调整抗COVID-19和ASM治疗。
