Epilepsy after the first drug fails: substitution or add-on?
Epilepsy after the first drug fails: substitution or add-on?
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DOI：
10.1053/seiz.2000.0442
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发表时间：
2000-10-01
影响因子：
3
通讯作者：
Brodie, MJ
中科院分区：
文献类型：
--
作者：
Kwan, P;Brodie, MJ
对于单一疗法无反应的患者，何时以及如何联合使用抗癫痫药物 (AED) 尚不清楚。我们对 248 名首次 AED 治疗失败的患者进行了前瞻性随访。当治疗因无法忍受的不良事件而失败时，会开出第二种（替代）药物。当失败是由于缺乏疗效时，可以采用 AED 替代或联合使用（附加）。如果患者至少 1 年没有癫痫发作，则被认为没有癫痫发作。在首次耐受性良好的 AED 中癫痫发作控制不充分的患者中，接受替代单一疗法 (n = 35) 和接受附加治疗 (n = 42) 的患者无癫痫发作率相似（替代与附加治疗：17% vs. 26%）和无法耐受副作用的发生率（替代与附加治疗：26% vs. 12%）。根据药物的主要作用模式，与其他组合（7%，P = 0.05）相比，当组合涉及钠通道阻滞剂和具有多种作用机制的药物时，更多患者（36%）不再癫痫发作。在第二种药物失败后接受附加治疗的 1-1 名患者中，无一例癫痫发作消失，而在第一种耐受 AED 被证明无效后立即接受附加治疗的患者中，这一比例为 26%（n = 42，P = 0.05）。这些初步观察结果产生了有关癫痫早期治疗的可验证的假设。一项比较第一个 AED 失败后的替代和联合治疗的随机研究正在进行中。 (C) 2000 东亚银行贸易有限公司
When and how a combination of antiepileptic drugs (AEDs) should be used in patients unresponsive to monotherapy is not known. We followed up prospectively 248 patients in whom treatment with the first AED was unsuccessful. When treatment failed due to intolerable adverse events, a second (substituted) drug was prescribed. When failure was due to lack of efficacy, either AED substitution or combination (add-on) was undertaken. Patients were considered to be seizure-free if they had no seizures for at least 1 year. Among patients with inadequate seizure control on the first well tolerated AED, those who received substituted monotherapy (n = 35) and those who received add-on treatment (n = 42) had similar seizure-free rates (substitution vs. add-on: 17% vs. 26%) and incidence of intolerable side effects (substitution vs. add-on: 26% vs. 12%). Based on the drugs' perceived primary mode of action, more patients became seizure-free when the combination involved a sodium channel blocker and a drug with multiple mechanisms of action (36%) compared to other combinations (7%, P = 0.05). None of the 1 1 patients who received add-on treatment after a second drug had also failed became seizure-free, compared to 26% in those who received add-on as soon as the first tolerated AED proved to be ineffective (n = 42, P = 0.05). These preliminary observations have generated verifiable hypotheses regarding the early management of epilepsy. A randomized study comparing substitution and combination after the failure of the first AED is underway. (C) 2000 BEA Trading Ltd.