Fromm G H
Department of Neurology, University of Pittsburgh, School of Medicine, Pennsylvania 15261.
Epilepsia. 1994;35 Suppl 5:S77-80. doi: 10.1111/j.1528-1157.1994.tb05975.x.
Gabapentin (GBP, Neurontin) is a novel antiepileptic drug (AED) that was shown to be effective against refractory partial seizures in five placebo-controlled trials. However, a number of patients with complex partial seizures experienced an increase in seizure frequency, suggesting that patients suffering from complex partial seizures are not a homogeneous group. In fact, we found that currently available AEDs are likely to be ineffective when staring is a prominent component of complex partial seizures. The poor response of this group of patients may reflect the fact that staring spells are inhibitory seizures and that the AEDs prescribed for partial seizures appear to facilitate inhibitory mechanisms. GBP resembles phenytoin (PHT) and carbamazepine (CBZ) in depressing segmental and reticular excitatory mechanisms and facilitating segmental inhibitory mechanisms, just as it resembles PHT and CBZ in efficacy against some partial seizures and against secondarily generalized seizures. Perhaps the patients in whom GBP increased seizure frequency had complex partial seizures with staring and were therefore unlikely to benefit from drugs such as GBP, CBZ, and PHT, which enhance inhibitory mechanisms in the brain. These findings suggest that future AED trials would greatly benefit from a categorization of complex partial seizures into nosologically distinct groups.
加巴喷丁（GBP，商品名Neurontin）是一种新型抗癫痫药物（AED），在五项安慰剂对照试验中显示对难治性部分性癫痫发作有效。然而，一些复杂部分性癫痫发作的患者癫痫发作频率增加，这表明患有复杂部分性癫痫发作的患者并非同质群体。事实上，我们发现当凝视是复杂部分性癫痫发作的突出成分时，目前可用的抗癫痫药物可能无效。这组患者反应不佳可能反映出凝视发作是抑制性癫痫发作，而用于部分性癫痫发作的抗癫痫药物似乎会促进抑制机制。加巴喷丁在抑制节段性和网状兴奋机制以及促进节段性抑制机制方面类似于苯妥英（PHT）和卡马西平（CBZ），就像它在对某些部分性癫痫发作和继发性全身性癫痫发作的疗效方面类似于苯妥英和卡马西平一样。也许加巴喷丁使癫痫发作频率增加的患者患有伴有凝视的复杂部分性癫痫发作，因此不太可能从加巴喷丁、卡马西平和苯妥英等增强大脑抑制机制的药物中获益。这些发现表明，未来的抗癫痫药物试验将从将复杂部分性癫痫发作分类为病因学上不同的组中大大受益。
