Sander J W
Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
Can J Neurol Sci. 1998 Aug;25(3):S16-8. doi: 10.1017/s0317167100034867.
Clinical trials are important in determining the relative efficacy and safety of a new antiepileptic drug (AED); however, experience acquired in clinical practice will eventually determine its position in the antiepileptic armamentarium. Topiramate (TPM), a new AED has been available in the United Kingdom since mid-1995 and a considerable number of patients have being treated. As a result of this experience, a number of changes have being made in the way TPM is used, particularly in the starting doses and titration rates. This seems to have improved patients' tolerability of treatment, an important consideration if a drug is to be used to its optimum level. In this article, practical tips for the use of TPM are given and these include starting doses, titration rates, options for managing side effects occurring early in treatment, advice concerning the withdrawal of concomitant AEDs and indications for discontinuation of TPM. The need for adequate patient counseling regarding potential side effects and expectations of treatment is also reviewed.
临床试验对于确定新型抗癫痫药物（AED）的相对疗效和安全性至关重要；然而，临床实践中积累的经验最终将决定其在抗癫痫药物库中的地位。托吡酯（TPM）是一种新型AED，自1995年年中起在英国上市，已有相当数量的患者接受治疗。基于这些经验，TPM的使用方式已发生了一些变化，尤其是起始剂量和滴定速率。这似乎提高了患者对治疗的耐受性，而如果要将一种药物使用到最佳水平，这是一个重要的考量因素。本文给出了使用TPM的实用建议，包括起始剂量、滴定速率、处理治疗早期出现的副作用的方法、关于停用联合使用的AED的建议以及停用TPM的指征。还回顾了就潜在副作用和治疗预期对患者进行充分咨询的必要性。
