Is refractory epilepsy preventable?
Is refractory epilepsy preventable?
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DOI：
10.1046/j.1528-1157.2002.38501.x
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发表时间：
2002-04-01
期刊：
影响因子：
5.6
通讯作者：
Serratosa, JM
中科院分区：
文献类型：
--
作者：
Arroyo, S;Brodie, MJ;Serratosa, JM
大约三分之一被诊断患有癫痫的患者不会被抗癫痫药物（AEDs）完全控制，其中许多人会频繁和致残性癫痫发作。这些患者将接受多种药物试验，大多数情况下没有完全缓解。此外，难治性癫痫与发病率增加（来自癫痫发作和药物治疗），社会孤立，失业和整体生活质量下降有关。有证据表明，难治性癫痫可以是一种进行性疾病，如果早期控制，可能永远不会发展成一个完整的综合征及其所有相关的后遗症。困难在于在早期阶段识别可能进展为难治性的患者。目前没有已知的标记物使临床医生能够有信心地进行这种鉴定。药物基因组学的进展和我们对癫痫药物反应性的理解可能会改变这种情况。即使是现在，我们也能够比以前更早地识别出许多预后不良的患者，特别是在儿科人群中，其中综合征分类可能提供一种预测难治性的方法。早期开始积极治疗可能会改善预后和整体生活质量。
About a third of the patients diagnosed with epilepsy will not be fully controlled with antiepileptic drugs (AEDs), and many of them will have frequent and disabling seizures. These patients will undergo multiple drug trials, most often without complete seizure remission. Moreover, refractory epilepsy is associated with increased morbidity (from seizures and medications), social isolation, unemployment, and overall reduced quality of life. There is evidence that refractory epilepsy can be a progressive disorder, which, if controlled early, might never develop into a full syndrome with all of its associated sequelae. The difficulty lies in identifying at an early stage patients who are likely to progress to intractability. No currently known markers enable clinicians to make this identification with confidence. Advances in pharmacogenomics and our understanding of pharmacologic responsiveness in epilepsy may change this situation. Even now, we are able to identify many patients with a poor prognosis earlier than before, particularly in the pediatric population, in which syndromic classification may provide an approach to predict intractability. The early initiation of aggressive therapy may improve outcome and overall quality of life.