Schmidt D
J Neurol Neurosurg Psychiatry. 1982 Dec;45(12):1119-24. doi: 10.1136/jnnp.45.12.1119.
The value of adding a second antiepileptic drug in intractable epilepsy with complex-partial seizures was studied in a long-term prospective trial in 30 adult patients who failed to respond to the maximum use of carbamazepine, phenytoin, phenobarbital or primidone as the first drug. Based on the individual previous history of one-drug treatment, the most promising antiepileptic drug (carbamazepine, clobazam, clonazepam, phenobarbital, phenytoin, primidone, valproic acid) was added, if necessary until clinical toxicity occurred. A reduction of the seizure frequency by more than 75% was seen in only four patients (13%) exposed to a second drug in the event of failure of optimum one-drug treatment. The remaining majority of patients (87%) did not benefit from the second drug; in three patients the seizure frequency increased by more than 100%. The common practice of adding another drug in difficult-to-treat cases may need to be reconsidered until further evidence is presented that two drugs are more beneficial than one drug in the treatment of intractable epilepsy.
在一项长期前瞻性试验中，对30例使用卡马西平、苯妥英、苯巴比妥或扑米酮作为一线药物最大剂量治疗无效的成年难治性复杂部分性癫痫患者，研究了添加第二种抗癫痫药物的价值。根据个体先前的单药治疗史，添加最有前景的抗癫痫药物（卡马西平、氯巴占、氯硝西泮、苯巴比妥、苯妥英、扑米酮、丙戊酸），必要时添加直至出现临床毒性。在最佳单药治疗失败后，接受第二种药物治疗的患者中只有4例（13%）癫痫发作频率降低超过75%。其余大多数患者（87%）未从第二种药物中获益；3例患者癫痫发作频率增加超过100%。在有更多证据表明两种药物比一种药物更有利于治疗难治性癫痫之前，在难治性病例中添加另一种药物的常见做法可能需要重新考虑。
