Pellock J M
Department of Neurology, Pediatrics, and Pharmacy and Pharmaceutics, Medical College of Virginia, Virginia Commonwealth University, Richmond.
Epilepsia. 1994;35 Suppl 4:S11-8. doi: 10.1111/j.1528-1157.1994.tb05951.x.
Antiepileptic drugs (AEDs) are administered to patients for acute and long-term treatment of seizures. Most patients with acute convulsions receive intravenous (i.v.) benzodiazepine (BZD), frequently followed by i.v. loading with phenytoin (PHT), especially when seizures continue. For patients with absence status epilepticus, BZD is usually followed by ethosuximide (ESM) or valproate (VPA). The decision to continue AED therapy is based on the likelihood that seizures will continue or recur. Once epilepsy is diagnosed, long-term treatment with AEDs is recommended, beginning with monotherapy. Two studies sponsored by the U.S. Veterans Administration (VA), which compared the efficacy of carbamazepine (CBZ), PHT, phenobarbital (PB), primidone (PRM), and VPA, recommend that most adults with recurrent partial seizures receive either CBZ or PHT. The 1992 VA study suggests that VPA is equal to CBZ or PHT in efficacy when partial seizures become secondarily generalized. Primary generalized epilepsies are most frequently treated with VPA when combinations of generalized seizures exist. ESM is prescribed most often when typical childhood absence seizures exist alone. Although many authorities do not recommend long-term treatment of childhood febrile seizures, PB is administered by some when febrile seizures have complex symptomatology. In general, AED monotherapy is currently preferred, but those with more refractory epilepsy receive polytherapy. CBZ, PHT, PB, PRM, VPA, and ESM are the primary AEDs prescribed in the United States. PHT, followed by CBZ and VPA, is the most frequently prescribed AED as both new and total prescriptions. The introduction of felbamate, gabapentin,and lamotrigine may alter these patterns in the future.
抗癫痫药物（AEDs）用于患者癫痫发作的急性和长期治疗。大多数急性惊厥患者接受静脉注射苯二氮䓬（BZD），随后常静脉注射负荷量苯妥英（PHT），尤其是在癫痫发作持续时。对于失神性癫痫持续状态患者，BZD之后通常使用乙琥胺（ESM）或丙戊酸盐（VPA）。是否继续使用AED治疗取决于癫痫发作持续或复发的可能性。一旦确诊癫痫，建议开始单药治疗进行长期AED治疗。美国退伍军人事务部（VA）资助的两项研究比较了卡马西平（CBZ）、PHT、苯巴比妥（PB）、扑米酮（PRM）和VPA的疗效，建议大多数复发性部分性癫痫的成年人使用CBZ或PHT。1992年VA的研究表明，当部分性癫痫继发全身性发作时，VPA在疗效上与CBZ或PHT相当。当存在全身性发作组合时，原发性全身性癫痫最常使用VPA治疗。当仅存在典型的儿童失神发作时，最常使用ESM。尽管许多权威机构不建议对儿童热性惊厥进行长期治疗，但当热性惊厥有复杂症状时，一些人会使用PB。一般来说，目前首选AED单药治疗，但那些癫痫更难治的患者接受联合治疗。CBZ、PHT、PB、PRM、VPA和ESM是美国最常用的主要AEDs。PHT是新开处方和总处方中最常开具的AED，其次是CBZ和VPA。非氨酯、加巴喷丁和拉莫三嗪的引入可能会在未来改变这些模式。
