A review of the pharmacotherapeutic considerations for managing epilepsy in people with autism.
A review of the pharmacotherapeutic considerations for managing epilepsy in people with autism.
复制标题
治疗自闭症患者癫痫的药物治疗注意事项综述。
DOI：
10.1080/14656566.2022.2055461
复制
发表时间：
2022
影响因子：
3.2
通讯作者：
Watkins LV
中科院分区：
文献类型：
--
作者：
Watkins LV
自闭症与其他神经发育障碍（NDD）一样，与癫痫有很强的关联。在自闭症和癫痫中有已知的共同遗传途径。也有特定的遗传综合征与复杂的癫痫和孤独症phenotype.Areas coveredThis审查探讨了共同的遗传病因和病理生理途径的证据，癫痫和孤独症。孤独症伴癫痫合并症与内科和精神科合并症的高患病率相关。本文讨论了这如何影响评估，治疗和结果。在NDD的背景下，治疗特定癫痫发作类型的证据也与临床评论一起检查。专家意见尽管有很强的相关性，但支持抗癫痫药物治疗自闭症的疗效和耐受性的证据基础有限，没有1级证据或国家指南可用。孤独症和癫痫应在NDD模型下进行治疗，并谨慎引入和滴定抗癫痫药物。除此之外，有证据支持在特定的遗传综合征（如多发性硬化症和其他遗传性癫痫发作疾病）中向精确医学迈进。局灶性癫痫的一线治疗包括卡马西平、拉莫三嗪和左乙拉西坦。
IntroductionAutism, like other neurodevelopmental disorders (NDDs), has a strong association with epilepsy. There are known common genetic pathways in both autism and epilepsy. There are also specific genetic syndromes associated with both complex epilepsy and the autism phenotype.Areas coveredThis review explores the evidence for common genetic etiologies and pathophysiological pathways in relation to both epilepsy and autism. Autism with comorbid epilepsy are associated with a high prevalence of medical and psychiatric comorbidities. This paper discusses how this influences assessment, treatment, and outcomes. The evidence for the treatment of specific seizure types in the context of NDDs is also examined alongside clinical commentary.Expert opinionDespite the strong association, there is a limited evidence base to support the efficacy and tolerability of anti-seizure medications specifically in autism, with no Level 1 evidence or National Guidance available. Autism and epilepsy should be approached under a NDD model with cautious introduction and titration of anti-seizure medication. Alongside this, there is evidence to support a move toward precision medicine in specific genetic syndromes such as Tuberous Sclerosis Complex and other genetic seizure disorders. The first-line treatments that should be considered for focal seizures include carbamazepine, lamotrigine, and levetiracetam.