McDonnell G V, Morrow J I
Department of Neurology, Royal Victoria Hospital, Belfast, UK.
Seizure. 1996 Jun;5(2):127-30. doi: 10.1016/s1059-1311(96)80106-3.
Three new antiepileptic drugs (AEDs) are finding increasing use in medical practice. To examine their efficacy and side-effect profile, 483 patients with epilepsy attending either a specialized epilepsy clinic or general neurology clinic under the care of a single consultant neurologist were reviewed. Of these patients 127 had received lamotrigine, 100 vigabatrin and 27 gabapentin. In all but three patients the indication had been epilepsy refractory to other treatments. Efficacy was confirmed if patients achieved a > 50% reduction in seizure frequency or became seizure free. By this criteria 36.3% of patients receiving lamotrigine, 29% receiving vigabatrin and 15% receiving gabapentin benefited significantly. Lack of efficacy was the major reason for discontinuing vigabatrin (27%) and gabapentin (33.3%) whereas an adverse event was the main reason in patients receiving lamotrigine (28.3%). A spectrum of adverse events were noted. Behavioural/psychological effects in particular occurred with all of the drugs and frequently necessitated drug withdrawal. There was also a suggestion of a pharmacodynamic interaction between lamotrigine and both carbamazepine and sodium valproate resulting in toxicity of these latter drugs in a few patients. Drug tolerance was suspected in 12% of patients receiving vigabatrin, less frequently in those on gabapentin and only rarely with lamotrigine.
三种新型抗癫痫药物（AEDs）在医学实践中的应用越来越广泛。为了研究它们的疗效和副作用情况，我们回顾了在一位神经科顾问医生照料下，前往专科癫痫诊所或普通神经科诊所就诊的483例癫痫患者。这些患者中，127例使用了拉莫三嗪，100例使用了氨己烯酸，27例使用了加巴喷丁。除3例患者外，其余患者的用药指征均为对其他治疗无效的癫痫。如果患者的癫痫发作频率降低超过50%或不再发作，则认定为疗效得到证实。按照这一标准，使用拉莫三嗪的患者中有36.3%、使用氨己烯酸的患者中有29%、使用加巴喷丁的患者中有15%显著获益。疗效不佳是停用氨己烯酸（27%）和加巴喷丁（33.3%）的主要原因，而不良事件则是使用拉莫三嗪患者停药的主要原因（28.3%）。记录到了一系列不良事件。特别是所有药物都出现了行为/心理效应，并且常常需要停药。还有迹象表明，拉莫三嗪与卡马西平和丙戊酸钠之间存在药效学相互作用，导致少数患者出现这两种药物的毒性反应。接受氨己烯酸治疗的患者中有12%疑似出现药物耐受性，接受加巴喷丁治疗的患者中出现的频率较低，而拉莫三嗪治疗的患者中则很少出现。
