Ferrendelli J A
Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110.
Neurology. 1995 Mar;45(3 Suppl 2):S12-6.
Many patients with epilepsy can be successfully treated with a single antiepileptic drug (monotherapy). However, in a substantial number of patients, monotherapy does not provide satisfactory seizure control, and the use of two or more drugs, or polypharmacy, is required. Selection of rational combination therapy requires consideration of the clinical antiepileptic or anticonvulsant effects, adverse effects, drug interactions, and relationship between effective and toxic drug levels. Mechanisms of action of each agent must also be studied. Optimal combination therapy often is achieved with drugs that have different mechanisms of action, relatively few adverse effects, high therapeutic indexes, and limited or no drug interactions. The goal of rational polypharmacy is to produce improved seizure control with minimal or no adverse effects.
许多癫痫患者使用单一抗癫痫药物（单药治疗）即可成功治愈。然而，相当一部分患者单药治疗无法实现令人满意的癫痫发作控制，因此需要使用两种或更多药物，即联合用药。合理选择联合治疗方案需要考虑临床抗癫痫或抗惊厥效果、不良反应、药物相互作用以及有效药物水平与毒性药物水平之间的关系。每种药物的作用机制也必须加以研究。最佳联合治疗方案通常采用作用机制不同、不良反应相对较少、治疗指数高且药物相互作用有限或无药物相互作用的药物。合理联合用药的目标是在产生最小不良反应或无不良反应的情况下改善癫痫发作控制。
