Beran Roy G
Neurology Department, Liverpool Hospital, Liverpool, NSW 2170, Australia.
South Western Clinical School, University of New South Wales, Sydney, NSW 2170, Australia.
Brain Sci. 2022 Apr 19;12(5):512. doi: 10.3390/brainsci12050512.
Antiseizure medications (ASMs) control 70-75% of seizures. Accepting stress as a trigger for seizures, intervention, at the time of predictable stress, should offer a therapeutic option. Mode of intervention: Intervention requires the maintenance of an accurate seizure diary to identify a recurring pattern. With a questioning approach to that diary, the clinician may intervene when stressful provocateurs occur. Benzodiazepines, such as clobazam, initiated prior to the predictable stress, and continued until after it has passed, should be short lived, making serious adverse effects unlikely. Benzodiazepines have a dual benefit, being both anxietolytic and raising the seizure threshold in patients with epilepsy.
Many patients claim stress provokes their seizures and may not be aware the stress was the provocateur, until after a seizure occurred, leading to a retrospective claim of the relationship. To confirm the relationship, permitting preventative measures, before exposure to provocative factors, often unable to be avoided, requires maintenance and review of a detailed diary. Interval temporary use of benzodiazepines, such as clobazam, or alternatively clonazepam, diazepam or nitrazepam, offers a reasonable response to obviate subsequent seizures, and should be continued, for a brief period, after the risk has abated. Subsequent review of the diary, over a period of repeated exposures to the identified stress, will confirm or refute the therapeutic effect.
Judicious use of interval therapy, with one of the benzodiazepines, covering the period of stressful provocation, offers adjunctive treatment of possible refractory epilepsy, based upon the review of the strictly maintained epilepsy/seizure diary.
抗癫痫药物（ASMs）可控制70%-75%的癫痫发作。若将压力视为癫痫发作的诱因，那么在可预测的压力出现时进行干预应是一种治疗选择。干预方式：干预需要记录准确的癫痫日记以识别复发模式。通过对该日记进行询问，临床医生可在压力诱发因素出现时进行干预。在可预测的压力出现之前开始使用苯二氮䓬类药物，如氯巴占，并持续至压力过去，此类药物作用时间短，不太可能产生严重不良反应。苯二氮䓬类药物有双重益处，既能抗焦虑，又能提高癫痫患者的癫痫发作阈值。
许多患者称压力会诱发癫痫发作，且可能直到癫痫发作后才意识到压力是诱发因素，从而事后回顾性地声称存在这种关系。为了证实这种关系，在接触往往无法避免的诱发因素之前允许采取预防措施，这需要记录并复查详细的日记。间歇性临时使用苯二氮䓬类药物，如氯巴占，或者也可使用氯硝西泮、地西泮或硝西泮，对于避免后续癫痫发作是一种合理的应对方法，并且在风险消退后应持续使用一段时间。在一段时间内反复接触已识别的压力后，对日记进行复查将证实或反驳治疗效果。
基于对严格记录的癫痫/癫痫发作日记的复查，明智地使用一种苯二氮䓬类药物进行间歇性治疗，涵盖压力诱发期，可为可能难治性癫痫提供辅助治疗。
