Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA
Boston Children’s Hospital, Harvard Medical School. Department of Neurology, Division of Epilepsy & Clinical Neurophysiology, Boston, MA, USA
Epileptic Disord. 2022 Oct 1;24(5):751-764. doi: 10.1684/epd.2022.1468.
In times of severe antiseizure medication (ASM) shortage due to emergency situations (e.g., disasters, conflicts, sudden disruption to international supply chains), management of people with epilepsy with available ASMs can be difficult. A group of experts was brought together by the International League Against Epilepsy (ILAE) to formulate recommendations for such circumstances. Every effort was made to base these recommendations on direct published literature or extrapolations from basic information available about ASMs. Actual published literature in this area is, however, limited, and at times, assumptions were made by the experts to generate these recommendations. During times of shortage of ASMs, switching between different ASMs (e.g., oxcarbazepine and carbamazepine) can occasionally be considered as a mitigation procedure. However, for many ASMs, the option of an overnight switch to another drug does not exist. Switching from brand to generic or between generic products has often been shown to be safe, if required. Finally, when supplies of benzodiazepines or equipment to administer medications intravenously are not available, rectal administration of some ASMs may be an emergency alternative route for treating serial seizures and status epilepticus. Decision-making with regard to treatment and possible options should be driven by what is best for the patient.
在紧急情况下（例如灾害、冲突、国际供应链突然中断）出现严重的抗癫痫药物（ASM）短缺时，管理有可用 ASM 的癫痫患者可能会很困难。国际抗癫痫联盟（ILAE）召集了一组专家，为这种情况制定建议。我们尽最大努力使这些建议基于 ASM 的直接已发表文献或可用的基本信息的推断。然而，该领域的实际已发表文献有限，有时专家们会做出假设来生成这些建议。在 ASM 短缺期间，偶尔可以考虑在不同的 ASM 之间进行转换（例如，奥卡西平和卡马西平）作为缓解措施。然而，对于许多 ASM 来说，并不存在从一种药物转换为另一种药物的 overnight 选择。如果需要，从品牌药物转换为仿制药或在仿制药之间进行转换通常是安全的。最后，当没有苯二氮䓬类药物供应或没有静脉内给药设备时，直肠内给药一些 ASM 可能是治疗连续发作和癫痫持续状态的紧急替代途径。治疗决策和可能的选择应该取决于对患者最有利的因素。
