Camfield P, Camfield C
Izaak Walton Killam Hospital for Children, Dalhousie University Medical School, Halifax, Nova Scotia.
Can J Neurol Sci. 1994 Aug;21(3):S7-11. doi: 10.1017/s0317167100040750.
Acute and chronic toxicity complicates all antiepileptic medications (AED) and is idiosyncratic. Acute toxicity can be categorized into 1) acute brain dysfunction or 2) acute organ dysfunction when AED's are started. Despite promising in vitro lymphocyte testing, anticipation of acute reactions cannot be offered. Furthermore, screening for AED toxicity by routine blood and urine tests in asymptomatic patients is of doubtful value and should be abandoned. Patients should be informed of possible reactions and immediately report early symptoms. Treatment for acute reactions is largely unstudied. It is unclear how to reintroduce AED's following acute reactions. Often patients are sensitive to drugs with a similar chemical structure. The "desensitization" protocol of Purvis may be of merit. Three major chronic toxicities of AED's have been noted--soft tissue and gum hypertrophy, progressive ataxia, and peripheral neuropathy. New AED's require careful post-marketing surveillance since long term toxicity data are not yet available.
急性和慢性毒性使所有抗癫痫药物（AED）变得复杂，且具有特异性。急性毒性可分为两类：1）开始使用AED时出现的急性脑功能障碍，或2）急性器官功能障碍。尽管体外淋巴细胞检测前景乐观，但无法预测急性反应。此外，对无症状患者进行常规血液和尿液检测以筛查AED毒性的价值存疑，应予以摒弃。应告知患者可能出现的反应，并要求他们立即报告早期症状。急性反应的治疗方法大多未经研究。尚不清楚急性反应后如何重新使用AED。患者通常对化学结构相似的药物敏感。Purvis的“脱敏”方案可能有可取之处。已注意到AED的三种主要慢性毒性——软组织和牙龈增生、进行性共济失调和周围神经病变。由于尚无长期毒性数据，新的AED需要进行仔细的上市后监测。
