Do we need any more new antiepileptic drugs?

被引:88
作者
Brodie, MJ [1 ]
机构
[1] Univ Glasgow, Western Infirm, Dept Med & Therapeut, Epilepsy Unit, Glasgow G11 6NT, Lanark, Scotland
关键词
epilepsy antiepileptic drugs; efficacy; toxicity; interactions;
D O I
10.1016/S0920-1211(01)00203-0
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
The last decade has seen the licensing of nine new antiepileptic drugs (AEDs) with more to come. Despite this, only 58 and 63% of patients with localisation-related and newly diagnosed epilepsy, respectively, had been seizure-free for more than a year in separate prospective outcome studies undertaken at the Epilepsy Unit in Glasgow. Data will be presented to support the hypothesis that adolescent and adult epileptic patients comprise two distinct populations. Around 60% will be controlled on monotherapy with the first or second choice AED, while the majority of the remainder is difficult-to-control It is for this latter group and the many pharmacoresistant paediatric patients with encephalopathic syndromes that we need new AEDs. For a successful clinical outcome, patients must be able to tolerate the treatment. Neurotoxic, sedative, cognitive and psychiatric symptoms, dysmorphic and other long-term side effects, and teratogenesis plague the current crop of AEDs. Pharmacokinetic and pharmacodynamic interactions complicate the situation still further. These problems may, in part, be a consequence of combining drugs with similar mechanisms of action. Unravelling the genetics of the epilepsies will provide a range of tempting targets for pharmacological intervention. We need, also, models of refractory epilepsy to help identify promising therapies. An efficient regulatory trial programme will ensure rapid availability of new AEDs for the many children and adults whose lives continue to be blighted by seizures. (C) 2001 Elsevier Science B.V. All rights reserved.
引用
收藏
页码:3 / 6
页数:4
相关论文
共 15 条
[1]   Randomised, placebo-controlled study of vigabatrin as first-line treatment of infantile spasms [J].
Appleton, RE ;
Peters, ACB ;
Mumford, JP ;
Shaw, DE .
EPILEPSIA, 1999, 40 (11) :1627-1633
[2]   Drug therapy - Antiepileptic drugs [J].
Brodie, MJ ;
Dichter, MA .
NEW ENGLAND JOURNAL OF MEDICINE, 1996, 334 (03) :168-175
[3]   DRUG-INTERACTIONS IN EPILEPSY [J].
BRODIE, MJ .
EPILEPSIA, 1992, 33 :S13-S22
[4]  
BRODIE MJ, 1999, EPILIPSIA, V40, pS98
[5]   Best practice guidelines for the management of women with epilepsy [J].
Crawford, P ;
Appleton, R ;
Betts, T ;
Duncan, J ;
Guthrie, E ;
Morrow, J .
SEIZURE-EUROPEAN JOURNAL OF EPILEPSY, 1999, 8 (04) :201-217
[6]   Drug therapy - New antiepileptic drugs [J].
Dichter, MA ;
Brodie, MJ .
NEW ENGLAND JOURNAL OF MEDICINE, 1996, 334 (24) :1583-1590
[7]  
Genton P, 2000, EPILEPTIC DISORD, V2, P99
[8]   POLYCYSTIC OVARIES AND HYPERANDROGENISM IN WOMEN TAKING VALPROATE FOR EPILEPSY [J].
ISOJARVI, JIT ;
LAATIKAINEN, TJ ;
PAKARINEN, AJ ;
JUNTUNEN, KTS ;
MYLLYLA, VV .
NEW ENGLAND JOURNAL OF MEDICINE, 1993, 329 (19) :1383-1388
[9]   Vigabatrin, a gabaergic antiepileptic drug, causes concentric visual field defects [J].
Kälviäinen, R ;
Nousiainen, I ;
Mäntyjärvi, M ;
Nikoskelainen, E ;
Partanen, J ;
Partanen, K ;
Riekkinen, P .
NEUROLOGY, 1999, 53 (05) :922-926
[10]   Long-term neuropsychological consequences of maternal epilepsy and anticonvulsant treatment during pregnancy for school-age children and adolescents [J].
Koch, S ;
Titze, K ;
Zimmermann, RB ;
Schröder, M ;
Lehmkuhl, U ;
Rauh, H .
EPILEPSIA, 1999, 40 (09) :1237-1243