Mattson R H
Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06511.
Neurology. 1994 Jun;44(6 Suppl 5):S4-9; discussion S31-2.
Significant progress in the classification, diagnosis, and pharmacologic management of epileptic seizures has occurred over the past two decades, but epilepsy remains a therapeutic challenge. Clinical studies show that most patients with epilepsy can have complete or almost complete seizure control with optimally managed monotherapy that employs a traditional antiepileptic drug (AED). About half of the remaining patients can obtain improved seizure control with combination antiepileptic drug therapy, but usually with more adverse effects. In the other half, seizures remain refractory to treatment with available antiepileptic drugs, or treatment remains problematic because of drug intolerance. Advances in understanding the pathogenesis of epilepsy and the mechanisms of action of antiepileptic drugs have provided a basis for the development of new AEDs that hold promise for difficult-to-treat patients. In this decade, a number of new AEDs that may overcome some of the disadvantages of traditional AEDs and offer clinicians and patients added therapeutic options will become clinically available. These will be more fully evaluated for their clinical potential to meet existing challenges of epilepsy treatment.
在过去二十年里，癫痫发作的分类、诊断及药物治疗方面已取得显著进展，但癫痫治疗仍然是一项挑战。临床研究表明，大多数癫痫患者通过使用传统抗癫痫药物（AED）进行优化管理的单一疗法，能够实现完全或几乎完全的癫痫发作控制。其余患者中约有一半通过联合抗癫痫药物治疗可使癫痫发作得到改善控制，但通常会出现更多不良反应。另一半患者的癫痫发作对现有抗癫痫药物治疗无效，或者由于药物不耐受，治疗仍存在问题。对癫痫发病机制和抗癫痫药物作用机制认识的进展为开发有望为难治性患者带来希望的新型抗癫痫药物奠定了基础。在这十年中，一些可能克服传统抗癫痫药物某些缺点并为临床医生和患者提供更多治疗选择的新型抗癫痫药物将可供临床使用。将对这些药物的临床潜力进行更全面的评估，以应对癫痫治疗现有的挑战。
