抗癫痫药物应用专家共识

被引：162

作者：

Electroencephalogram and Epilepsy Chapter

Chinese Society of Neurology

机构：

[1] 中华医学会神经病学分会脑电图与癫痫学组

来源：

中华神经科杂志 | 2011年 / 01期

关键词：

癫痫; 药物疗法; 问卷调查;

D O I：

暂无

中图分类号：

R742.1 [癫痫];

学科分类号：

1002 ;

摘要：

目的编制我国抗癫痫药物应用专家共识。方法采用无记名问卷调查形式,收集我国三级医院中成人神经科专科医生有关抗癫痫药物的应用经验与评价。调查内容为特发性全面性癫痫与症状性部分性癫痫的药物治疗,以及特殊人群与伴有共患病患者的抗癫痫药物应用。药物评价标准采用九级分级制。药物治疗策略评价根据专家评分所得均数、标准差与95%可信区间(95%CI),分为首选药物、一线、二线与三线药物。结果发出问卷50份,回收49份(98%)。49名专家中,男性38名(77.6%),女性11名(22.4%),年龄(53.9±10.8)岁(35～81岁),平均从业时间(17.9±10.2)年(3～45年),所有专家每月诊治癫痫患者20～800例(中位数100例)。总体治疗策略中,有关特发性全面性癫痫与症状性部分性癫痫的首选治疗,100%的专家选择单药。丙戊酸是新诊断特发性全面性癫痫的一线药物且惟一的首选药物。症状性部分性癫痫的初始药物首选均为卡马西平和奥卡西平。在特发性全面性癫痫药物治疗中,丙戊酸是与其他药物联合治疗的首选药物。症状性部分性癫痫的药物治疗中,卡马西平(奥卡西平)+托吡酯、卡马西平(奥卡西平)+左乙拉西坦、卡马西平(奥卡西平)+丙戊酸、丙戊酸+拉莫三嗪等是常用配伍。拉莫三嗪为健康育龄期妇女特发性全面性癫痫与症状性部分性癫痫的首选用药;伴抑郁的癫痫患者,特发性全面性发作的首选用药为丙戊酸与拉莫三嗪,继发性部分性发作的首选用药为拉莫三嗪、奥卡西平与卡马西平;伴有乙肝的癫痫患者,无论肝功能是否正常,特发性全面性发作的首选用药为托吡酯与左乙拉西坦,肝功能正常的继发性部分性患者,首选用药为奥卡西平,肝功能指标异常时,首选用药为托吡酯与左乙拉西坦;急诊室中的癫痫患者(不确定类型)首选丙戊酸与左乙拉西坦。结论本共识归纳专家的临床经验,将对癫痫的药物治疗有帮助。

引用

页码：56 / 65

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