When antiepileptic drugs aggravate epilepsy
When antiepileptic drugs aggravate epilepsy
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DOI：
10.1016/s0387-7604(99)00113-8
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发表时间：
2000-03-01
影响因子：
1.7
通讯作者：
Genton, P
中科院分区：
文献类型：
--
作者：
Genton, P
奇怪的是，抗癫痫药（AED）可能会加重癫痫。AED的数量正在稳步增加，矛盾加重的发生可能会成为一个经常性的问题。癫痫治疗患者的总体状态可能会因癫痫诊断的不适应、不必要的副作用、过量和耐受性的发生而改变。然而，恶化的主要机制是发生了相反的药效学效应。AED的具体效果是，它在大多数情况下控制癫痫，在其他情况下增加癫痫发作。特发性全身性癫痫（IGE）特别容易发生药效学恶化：卡马西平（CBZ）、氨己烯酸、噻加宾、加巴喷丁不断增加典型的失神，而苯妥英（PHT）则不太严重。青少年肌阵挛性癫痫常因CBZ而加重，PHT和其他AEDs则不常加重。IGE中发现的全身强直阵挛性癫痫发作可能对加重其他癫痫发作类型的AED有反应。在有症状的全身性癫痫中，患者通常有几种对AED反应不同的癫痫发作类型：肌阵挛通常会因加重IGE的相同药物而加重; Lennox-Gastaut综合征中的强直性癫痫发作对CBZ有反应，但可能会加重非典型性失神。在婴儿期严重肌阵挛性癫痫中，拉莫三嗪有几乎恒定的加重作用。在一些良性罗兰癫痫患者中，CBZ可能会导致明显的加重，出现负性肌阵挛、非典型失神、跌倒发作，并在睡眠期间最大程度地演变为癫痫电持续状态。在其他局灶性癫痫中，很难确定特定的药理学敏感性，但明显会发生加重。在治疗癫痫时，临床医生应根据发作类型，或更好地根据癫痫类型采取行动。患者通常会在医生面前意识到病情的恶化：每当他们表达对AED的“不喜欢”时，我们都应该仔细倾听。(C)2000 Elsevier Science B. V.保留所有权利。
Paradoxically, an antiepileptic drug (AED) may aggravate epilepsy. The number of AEDs is steadily increasing, and the occurrence of paradoxical aggravation will probably become a frequent problem. The overall status of the patient treated for epilepsy can be altered due to maladjustment to the diagnosis of epilepsy, to unwanted side-effects, to overdosage and to the occurrence of tolerance. However, the main mechanism of aggravation is the occurrence of an inverse pharmacodynamic effect. The specific effect of the AED is such that it controls epilepsy in most cases and increases seizures in other cases. Idiopathic generalised epilepsies (IGE) are particularly prone to pharmacodynamic aggravation: typical absences are constantly increased by carbamazepine (CBZ), vigabatrin, tiagabine, gabapentin, while phenytoin (PHT) is less aggravating. Juvenile myoclonic epilepsy is often aggravated by CBZ, less constantly by PHT and other AEDs. Generalised tonic-clonic seizures found in IGEs may respond to AEDs that aggravate the other seizure types. In symptomatic generalised epilepsies, patients have often several seizure types that respond differently to AEDs: myoclonias are generally aggravated by the same drugs that aggravated IGEs; tonic seizures in the Lennox-Gastaut syndrome respond to CBZ, which may however aggravate atypical absences. In severe myoclonic epilepsy of infancy, there is a nearly constant aggravating effect of lamotrigine. In some patients with benign rolandic epilepsy, a clear aggravation may be produced by CBZ, with occurrence of negative myoclonias, atypical absences, drop attacks, and at the maximum evolution into a state of electrical status epilepticus during sleep. It is much more difficult to pinpoint specific pharmacological sensitivity in other focal epilepsies, but aggravation clearly occurs. When treating epilepsy, the clinician should act according to seizure type, or, better, to epilepsy type. Patients are usually aware of aggravation before their doctors: we should listen carefully whenever they express a 'dislike' for an AED. (C) 2000 Elsevier Science B.V. All rights reserved.