Issues related to symptomatic and disease-modifying treatments affecting cognitive and neuropsychiatric comorbidities of epilepsy.
Issues related to symptomatic and disease-modifying treatments affecting cognitive and neuropsychiatric comorbidities of epilepsy.
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DOI：
10.1111/epi.12298
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发表时间：
2013-08
期刊：
影响因子：
5.6
通讯作者：
Scharfman HE
中科院分区：
文献类型：
--
作者：
Brooks-Kayal AR;Bath KG;Berg AT;Galanopoulou AS;Holmes GL;Jensen FE;Kanner AM;O'Brien TJ;Whittemore VH;Winawer MR;Patel M;Scharfman HE
许多神经或精神疾病的症状，如认知障碍、抑郁、焦虑、注意力缺陷和偏头痛，在癫痫患者中比在普通人群中更常见。这些不同的合并症对癫痫患者及其护理人员来说是一个未被充分认识的问题，因为它们降低了生活质量，使治疗复杂化，并增加了死亡率。事实上，有研究表明，合并症对癫痫患者的生活质量的影响比癫痫发作本身更大。越来越多的人认识到癫痫认知和行为共病的频率和影响，2012年医学研究所关于癫痫的报告中强调了这一点。合并症也被公认为美国国立卫生研究院（NIH）癫痫研究的基准领域。然而，在开发专门针对合并症的新疗法方面取得的进展相对较小。另一方面，在了解基本机制方面取得了许多进展。这些进展使得有可能确定治疗和预防的新靶点。作为国际抗癫痫联盟/美国癫痫学会关于癫痫临床前治疗开发研讨会的一部分，我们的工作组考虑了与癫痫合并症治疗开发相关的术语，模型和策略的理解现状。在此，我们总结了我们的研究结果，并提出了加速新疗法开发的方法。我们还考虑了改善研究的重要问题，包括与方法学，非药物治疗，生物标志物和基础设施有关的问题。
Many symptoms of neurologic or psychiatric illness—such as cognitive impairment, depression, anxiety, attention deficits, and migraine—occur more frequently in people with epilepsy than in the general population. These diverse comorbidities present an underappreciated problem for people with epilepsy and their caregivers because they decrease quality of life, complicate treatment, and increase mortality. In fact, it has been suggested that comorbidities can have a greater effect on quality of life in people with epilepsy than the seizures themselves. There is increasing recognition of the frequency and impact of cognitive and behavioral comorbidities of epilepsy, highlighted in the 2012 Institute of Medicine report on epilepsy. Comorbidities have also been acknowledged, as a National Institutes of Health (NIH) Benchmark area for research in epilepsy. However, relatively little progress has been made in developing new therapies directed specifically at comorbidities. On the other hand, there have been many advances in understanding underlying mechanisms. These advances have made it possible to identify novel targets for therapy and prevention. As part of the International League Against Epilepsy/American Epilepsy Society workshop on preclinical therapy development for epilepsy, our working group considered the current state of understanding related to terminology, models, and strategies for therapy development for the comorbidities of epilepsy. Herein we summarize our findings and suggest ways to accelerate development of new therapies. We also consider important issues to improve research including those related to methodology, nonpharmacologic therapies, biomarkers, and infrastructure.
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