Epilepsy in adults
Epilepsy in adults
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DOI：
10.1002/ana.410090103
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发表时间：
1981-01
影响因子：
11.2
通讯作者：
E. So;J. Penry
中科院分区：
文献类型：
--
作者：
E. So;J. Penry
过去十年，癫痫患者的治疗取得了进展。实用的长期脑电图技术（无论是否同步视频记录）的发展提高了癫痫类型诊断的准确性。该技术还为临床医生和研究人员提供了一种确定抗癫痫药物临床疗效并确定其治疗血清浓度的方法。计算机断层扫描增强了结构性脑损伤的识别。大多数报告的 CT 异常包括弥漫性和局灶性萎缩、轻度心室扩张和孔脑畸形。无论年龄或癫痫类型如何，CT 都能在 8% 至 10% 的患者中检测到肿瘤。抗癫痫药物治疗的新概念是基于对每种药物特有的药理学特性的认识而发展起来的。必须利用血清抗癫痫药物水平的测定来减少一名患者与另一名患者之间以及同一患者不同时间的药代动力学变异性问题，以便可以个体化剂量，以最小的毒性实现最大的治疗效果。对癫痫妇女怀孕的文献回顾表明，三分之一到一半的人在怀孕期间经历了更多的癫痫发作。最近观察到大多数抗癫痫药物的血清水平在妊娠期间降低。服用抗癫痫药物的癫痫女性的婴儿发生先天性异常的风险是非癫痫女性的婴儿的两到三倍。然而，除恶唑烷二酮类药物外，迄今为止的证据尚未证明抗癫痫药物具有致畸性。遗传因素的作用和妊娠期间癫痫发作的影响尚未确定。
The past decade has seen advances in the management of patients with epilepsy. The development of practical long‐term electroencephalographic techniques, with or without simultaneous video recording, has increased the accuracy of diagnosis of seizure types. The technique also provides clinicians and investigators with a method for establishing the clinical efficacy of antiepileptic drugs and determining their therapeutic serum concentrations. Computerized tomography has enhanced the identification of structural brain lesions. Most of the reported CT abnormalities consist of diffuse and focal atrophies, mild ventricular dilatations, and porencephalies. CT has detected tumors in 8 to 10% of the patients regardless of age or type of seizure involved. New concepts of antiepileptic drug therapy have developed from the recognition of pharmacological properties peculiar to each agent. Determination of serum antiepileptic drug levels has to be utilized to reduce the problem of pharmacokinetic variability from one patient to another and in the same patient at different times, so that dosage can be individualized to achieve maximum therapeutic effects with least toxicity. Review of the literature on pregnancy in epileptic women shows that a third to half experienced more seizures during gestation. Reduced serum levels of most antiepileptic drugs have recently been observed during gestation. Infants of epileptic women taking antiepileptic drugs have a two to three times greater risk for congenital anomalies than infants of nonepileptic women. However, with the exception of oxazolidinediones, evidennce to date has not proved the teratogenicity of antiepileptic drugs. The role of genetic factors and the effect of seizures during pregnancy have not been determined.