Jin Kazutaka
Department of Epileptology, Tohoku University Graduate School of Medicine.
Brain Nerve. 2023 Apr;75(4):347-351. doi: 10.11477/mf.1416202337.
Medical treatment is the primary therapy option for patients with epilepsy. Recently, the International League Against Epilepsy (ILAE) proposed that the current medications used to treat epilepsy should be referred to as 'antiseizure medications' (ASMs) due to the symptomatic effect exerted against seizures. The present article reviews the recent clinical practice guidelines (Clinical Practice Guidelines for Epilepsy 2018, in Japan, and the NICE guideline, published in April 2022) and expert opinions (USA, South Korea, and Spain) based on which the selection of ASMs has been discussed. The classification of seizure types and epilepsies should be examined before selecting the ASMs for each patient with epilepsy. For focal epilepsy, lamotrigine, levetiracetam, and lacosamide would be the first-line ASM, whereas, for generalized epilepsy, valproic acid, lamotrigine, and levetiracetam would be the first-line ASM. However, valproic acid is not to be prescribed to women of childbearing potential.
药物治疗是癫痫患者的主要治疗选择。最近，国际抗癫痫联盟（ILAE）提议，鉴于目前用于治疗癫痫的药物对癫痫发作具有对症治疗作用，应将其称为“抗癫痫发作药物”（ASMs）。本文回顾了近期的临床实践指南（日本的《2018年癫痫临床实践指南》以及2022年4月发布的英国国家卫生与临床优化研究所指南）和专家意见（来自美国、韩国和西班牙），基于这些指南和意见讨论了ASMs的选择。在为每位癫痫患者选择ASMs之前，应先检查癫痫发作类型和癫痫症的分类。对于局灶性癫痫，拉莫三嗪、左乙拉西坦和拉科酰胺将是一线ASMs，而对于全身性癫痫，丙戊酸、拉莫三嗪和左乙拉西坦将是一线ASMs。然而，丙戊酸不应开给有生育潜力的女性。
