Meinardi H, Binnie C D, Meijer J W
Electroencephalogr Clin Neurophysiol Suppl. 1985;37:201-14.
Pharmacological studies form an important adjunct to epilepsy monitoring and conversely long-term EEG and video recording are of value for assessing antiepileptic drug (AED) effects. Clinical estimates of the incidence of brief frequent seizures as absences is often difficult but greater reliability can be achieved by long-term monitoring of the seizures themselves or of the associated EEG discharges. There are, however, very marked spontaneous short-term fluctuations in discharge rates and the amounts of ictal epileptiform activity in short conventional EEGs rarely provide any useful index of AED action. Acute investigations are of value for assessing new AEDs or experimental methods of administration and for pharmacokinetic studies. For this purpose either spontaneous EEG discharges or photosensitivity may provide quantitative measures of antiepileptic effect. Long-term AED monitoring by means of an indwelling catheter indicates the time course of blood drug levels to be more complex and variable than might be expected from simple pharmacokinetic models. Short-term fluctuations in AED concentrations have little effect on epileptiform EEG activity or seizure control but are often responsible for intermittent side-effects. Conversely diagnostic EEG and monitoring studies may be required to classify seizures as an aid to determining appropriate medication and may explain apparent resistance to therapy, due to pseudo-seizures, reflex or self-induced epilepsy. Finally a case is presented for combined pharmacological EEG and video-monitoring in the preliminary assessment of new AEDs in order to improve the design of subsequent clinical trials.
药理学研究是癫痫监测的重要辅助手段，反之，长期脑电图和视频记录对于评估抗癫痫药物（AED）的效果也具有重要价值。临床上往往难以估计短暂频繁发作（如失神发作）的发生率，但通过对发作本身或相关脑电图放电进行长期监测，可以获得更高的可靠性。然而，在常规短程脑电图中，放电频率和发作期癫痫样活动量存在非常明显的自发短期波动，很少能提供任何有关AED作用的有用指标。急性研究对于评估新型AED或给药的实验方法以及药代动力学研究具有重要价值。为此，自发脑电图放电或光敏性均可提供抗癫痫效果的定量指标。通过留置导管进行长期AED监测表明，血药浓度的时间过程比简单药代动力学模型预期的更为复杂和多变。AED浓度的短期波动对癫痫样脑电图活动或发作控制影响不大，但往往是间歇性副作用的原因。反之，可能需要进行诊断性脑电图和监测研究，以对发作进行分类，辅助确定合适的药物治疗，并解释由于假性发作、反射性或自我诱发癫痫导致的明显治疗抵抗。最后，本文提出在新型AED的初步评估中联合进行药理学脑电图和视频监测，以改进后续临床试验的设计。
