Sperling Michael R, Rosenfeld William E, Watson John, Klein Pavel
Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Comprehensive Epilepsy Care Center for Children and Adults, St. Louis, Missouri, USA.
Epilepsia. 2025 Mar;66 Suppl 1(Suppl 1):4-14. doi: 10.1111/epi.18307.
People with epilepsy who have uncontrolled seizures are at increased risk of all-cause mortality, injuries, comorbidities, mood and psychosocial disorders, and diminished quality of life. For those with focal epilepsy, focal to bilateral tonic-clonic seizures (FBTCS) pose the greatest risk for sudden unexpected death in epilepsy (SUDEP), a leading cause of premature mortality in people with epilepsy. Cenobamate is a third-generation antiseizure medication with demonstrated efficacy in controlling focal seizures, including FBTCS, in people with drug-resistant epilepsy. Treatment with cenobamate in clinical trials was associated with a reduction in all-cause mortality to a rate statistically indistinguishable from that seen in the general population, and SUDEP rates were lower than expected. As FBTCS are associated with the highest risk of death, prevention of this seizure type is especially important, and physicians should continue to try new therapies to prevent these seizures. A shared decision-making model should be used when interacting with patients and their care providers to achieve and maintain seizure control and maximize treatment outcomes.
癫痫发作不受控制的患者全因死亡、受伤、合并症、情绪及心理社会障碍的风险增加，生活质量下降。对于局灶性癫痫患者，局灶性至双侧强直阵挛发作（FBTCS）是癫痫猝死（SUDEP）的最大风险因素，而SUDEP是癫痫患者过早死亡的主要原因。司替戊醇是一种第三代抗癫痫药物，在控制耐药性癫痫患者的局灶性发作（包括FBTCS）方面已显示出疗效。在临床试验中，司替戊醇治疗可使全因死亡率降低至与普通人群统计学上无差异的水平，且SUDEP发生率低于预期。由于FBTCS与最高的死亡风险相关，预防这种发作类型尤为重要，医生应继续尝试新的疗法来预防这些发作。在与患者及其护理人员互动时，应采用共同决策模型，以实现并维持癫痫发作的控制，并使治疗效果最大化。
