Iváñez V
Servicio de Neurologia, Hospital La Paz, Madrid.
Rev Neurol. 1995 Nov-Dec;23(124):1214-9.
Epilepsy is considered as being untreatable when attacks present unsatisfactory control or else when brought under control only with doses of anti-epileptic drugs which produce severe secondary effects. There has to be provable certainty that the anti-epileptic drugs were used correctly. Untreatable epilepsy is an essential condition for surgical intervention; consequently rigorous therapeutic and diagnostic criteria are needed which may also improve control of the attacks. About 20% of epilepsies are untreatable. The basic mechanisms of untreatable epilepsy are not well known and may be untreatable either from onset or as a consequence in the progression of the epileptogenetic process. Various factors may be involved in a bad prognosis. Spontaneous improvement is rare from the therapeutic point of view and before considering surgery at least two anti-epileptic drugs should be tried monotherapeutically prior to their use in combination. It is well known that bitherapy brings about an important improvement in a few cases. Anti-epileptic drugs should be used at their maximum tolerable dosage independently of theoretical plasmatic levels.
当癫痫发作控制不佳，或者仅通过使用会产生严重副作用的抗癫痫药物剂量才能得到控制时，癫痫被认为是无法治疗的。必须有可证明的确定性，即抗癫痫药物的使用是正确的。无法治疗的癫痫是手术干预的必要条件；因此，需要严格的治疗和诊断标准，这也可能改善对发作的控制。大约20%的癫痫是无法治疗的。无法治疗的癫痫的基本机制尚不清楚，可能从发病开始就无法治疗，或者是癫痫发生过程进展的结果。预后不良可能涉及多种因素。从治疗角度来看，自发改善很少见，在考虑手术之前，至少应先单独试用两种抗癫痫药物，然后再联合使用。众所周知，联合治疗在少数情况下会带来重要改善。抗癫痫药物应使用其最大耐受剂量，而不考虑理论血浆水平。
