Role of new and established antiepileptic drugs.
Role of new and established antiepileptic drugs.
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新的和已建立的抗癫痫药物的作用。
DOI：
10.1111/j.1528-1157.1998.tb05141.x
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发表时间：
1998
期刊：
影响因子：
5.6
通讯作者：
Leppik,IE
中科院分区：
文献类型：
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作者：
Leppik,IE
在 1857 年引入溴化物之前 (l)，尽管使用了许多药剂和混合物，但尚无有效的癫痫治疗方法。苯巴比妥 (PB) 于 1912 年推出，生酮饮食于 1922 年推出，同年苯妥英 (PHT) 推出，这是一种市售的癫痫药物“Gelineau Drag-Ces”，由溴化物、砷和印防己毒素组成。所有这些治疗方法都是凭经验使用的，在用于人类之前没有进行安全性和有效性的动物测试。 PHT 是第一个在动物身上进行有效性和安全性测试的抗癫痫药物 (AED)，这证明了科学方法在发现治疗癫痫新药方面的力量。从那时起，开发新药和了解其作用机制的进展步伐加快了。这使得许多国家在癫痫治疗方案上有了更多的选择。然而，由于监管问题，各国在批准使用这些物质方面仍存在很大差异。例如，唑尼沙胺（ZNS）仅在日本和韩国有售，而非氨酯（FBM）、加巴喷丁（GBP）、拉莫三嗪（LTG）、噻加宾（TGB）、托吡酯（TPM）和氨己烯酸（VGB）在大多数发达国家都有售。本综述是受 1997 年 9 月在日本癫痫协会的一次演讲启发而进行的，重点关注日本尚未上市的新药。此外，由于有许多选择，它还正确看待现有 AED 的作用。我更喜欢“既定”这个词，而不是“老”，因为除了 PHT 之外，所有广泛使用的 AED 都比 I 更年轻。选择合适的 AED 并不是一个简单的过程。 AED 的作用机制存在显着差异，因此其对特定癫痫综合征的临床疗效也存在显着差异（表 1）。仅仅识别患者是否患有癫痫并开出任何 AED 处方已经不够了。为了进行适当的治疗，必须使用脑电图检查来识别癫痫综合征
Before bromide was introduced in 1857 (l), there were no effective treatments for epilepsy, although many po-tions and concoctions were used. Phenobarbital (PB) was introduced in 1912, the ketogenic diet in 1922 and, in 1938, the year phenytoin (PHT) was introduced, one of the marketed remedies for epilepsy,“Gelineau Drag-Ces,” consisted of bromide, arsenic, and picrotoxin. All these treatments were used empirically and were not subjected to animal testing for safety and efficacy before being used in humans. PHT was the first antiepileptic drug (AED) to be tested in animals for efficacy and safety, which demonstrated the power of the scientific approach in discovering new drugs for the treatment of epilepsy. Since then, the pace of progress in developing new drugs and understanding their mechanisms of action has accelerated. This has led to more choices in many countries in the treatment options for epilepsy. However, due to regulatory issues, there remain great differences between countries in approval for use of these substances. For example, zonisamide (ZNS) is available only in Japan and Korea, whereas felbamate (FBM), gabapentin (GBP), lamotrigine (LTG), tiagabine (TGB), topiramate (TPM), and vigabatrin (VGB) are available in most developed countries. The present review was stimulated by a presentation to the Japanese Epilepsy Society in September 1997 and focuses on the new agents not yet available in Japan. In addition, it places in perspective the role of established AEDs now that many options are available. I prefer the term established, rather than “old” because, except for PHT, all of the widely used AEDs are younger than I.Selection of the appropriate AED is not a simple process. AEDs differ significantly in their mechanisms of action and consequently in their clinical efficacy in specific epilepsy syndromes (Table 1). It is no longer sufficient to recognize the presence of epiIepsy in a patient and prescribe just any AED. For appropriate treatment, one must identify the epilepsy syndrome using EEG cri-