Schmidt D
Fortschr Neurol Psychiatr. 1983 Nov;51(11):363-86. doi: 10.1055/s-2007-1002241.
Current trends and controversies in the antiepileptic drug therapy are reviewed from a clinical view. The usefulness of prophylactic therapy of febrile seizures and posttraumatic seizures or posttraumatic epilepsy is compromised by difficulties in the management of the patients especially by noncompliance. Previously untreated epilepsies can be treated successfully in 70--80% of the patients. Phenytoin or carbamazepine are equally effective for generalized tonic-clonic seizures of focal seizures, while absence seizures are controlled by ethosuximide or valproic acid. Only when the epilepsy is uncontrolled despite high plasma concentrations which cannot be raised because of side effects, a second drug should be given. A second drug is successful in about one out of six patients with focal epilepsy. Phenytoin, carbamazepine, phenobarbital and primidone seem to be equally effective for these drug-resistant cases. Status epilepticus can be treated with intravenous diazepam or phenytoin and, if necessary, with an infusion of phenytoin. Rectal diazepam is useful for acute pediatric therapy. Drugs of second choice are clonazepam, phenobarbital, lidocaine, and clomethiazole. In the pregnant epileptic patient a drop in the plasma concentration of antiepileptic drugs mainly through non-compliance and seizure provocation through sleep deprivation are major sources for the deterioration of epilepsies during pregnancy. The "fetal antiepileptic drug syndrome", malformations and an increased risk for epilepsy in the child are discussed as an interaction of parental epilepsy and drug-exposure during pregnancy. Finally, the interpretation of abnormal clinical chemistry data is reviewed. Disorders of the liver, bone, thyroid gland and blood are rarely seen in treated epileptic patients usually when specific risk factors are present. The over-interpretation of laboratory abnormalities e.g. an isolated increase of gamma-GT may lead to iatrogenic deterioration of epilepsy when the effective dose of the drug is reduced for unfounded fear of hepatic toxicity.
从临床角度对当前抗癫痫药物治疗的趋势和争议进行了综述。热性惊厥、创伤后惊厥或创伤后癫痫的预防性治疗的有效性因患者管理困难而受到影响，尤其是不依从性。以前未经治疗的癫痫患者中，70%-80%可以得到成功治疗。苯妥英或卡马西平对全身性强直阵挛发作或局灶性发作同样有效，而失神发作则由乙琥胺或丙戊酸控制。只有当癫痫在血浆浓度很高时仍无法控制，且由于副作用无法提高血浆浓度时，才应给予第二种药物。第二种药物对约六分之一的局灶性癫痫患者有效。苯妥英、卡马西平、苯巴比妥和扑米酮对这些耐药病例似乎同样有效。癫痫持续状态可用静脉注射地西泮或苯妥英治疗，必要时可静脉输注苯妥英。直肠用地西泮对小儿急性治疗有用。二线药物有氯硝西泮、苯巴比妥、利多卡因和氯美噻唑。在妊娠癫痫患者中，抗癫痫药物血浆浓度下降主要是由于不依从性，以及睡眠剥夺诱发癫痫发作，这是妊娠期癫痫病情恶化的主要原因。讨论了“胎儿抗癫痫药物综合征”、畸形以及儿童癫痫风险增加，这些是父母癫痫与孕期药物暴露相互作用的结果。最后，对异常临床化学数据的解读进行了综述。在接受治疗的癫痫患者中，肝脏、骨骼、甲状腺和血液疾病很少见，通常是在存在特定风险因素时才会出现。例如，因无端担心肝毒性而降低药物有效剂量，对实验室异常（如γ-谷氨酰转移酶单独升高）的过度解读可能导致癫痫医源性恶化。
