Ostendorf Adam, Waldman Genna J, Jehi Lara, Ilyas Mohammed, Naritoku Dean, Goldman Alica M
Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA.
Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
Epilepsy Curr. 2024 Dec 19:15357597241304501. doi: 10.1177/15357597241304501.
Initiation and maintenance of antiseizure therapy can be relatively straightforward in most patients. Depending on epilepsy type, patients may be more or less likely to enter remission or a resolution of their epilepsy and the International League Against Epilepsy developed clinically guiding definitions in this regard. The mechanisms by which resolution or remission are achieved are poorly understood which complicates clinical decision making and risk estimate for future seizure relapse. The impetus for the maintenance of medical therapy in a seizure-free patient is also age-dependent. In children, one ought to consider the unknown effects of antiseizure medications on the developing brain while family planning, lifestyle, education, or employment are some of the issues that affect the decision making in adults. Patients who enter remission following surgical remediation of their epilepsy represent a distinct category and medication discontinuation is influenced by a number of factors. Another important consideration is comorbidities that often affect medication choices and maintenance. When formulating a management strategy, patient preferences together with careful evaluation and precise and accurate epilepsy diagnosis are key towards guiding medical or surgical management, prognostication for seizure freedom, relapse risk, options for medication discontinuation, and understanding risks and types of comorbidities.
在大多数患者中，启动和维持抗癫痫治疗相对简单直接。根据癫痫类型，患者进入癫痫缓解期或癫痫得到控制的可能性或多或少会有所不同，国际抗癫痫联盟在这方面制定了临床指导定义。实现缓解或控制的机制尚不清楚，这使得临床决策和未来癫痫复发风险评估变得复杂。在无癫痫发作的患者中维持药物治疗的动力也与年龄有关。对于儿童，在进行计划生育时应考虑抗癫痫药物对发育中大脑的未知影响，而生活方式、教育或就业等问题则会影响成年人的决策。癫痫手术治疗后进入缓解期的患者属于一个独特的类别，停药受多种因素影响。另一个重要的考虑因素是合并症，它常常会影响药物选择和维持治疗。在制定管理策略时，患者的偏好以及仔细的评估、准确精确的癫痫诊断是指导药物或手术治疗、预测无癫痫发作、复发风险、停药选择以及了解合并症风险和类型的关键。
