Drug treatment of epilepsy: When does it fail and how to optimize its use?

被引:73
作者
Kwan, P
Brodie, MJ [1 ]
机构
[1] Western Infirm & Associated Hosp, Epilepsy Unit, Glasgow G11 6NT, Lanark, Scotland
[2] Chinese Univ Hong Kong, Dept Med & Therapeut, Prince Wales Hosp, Div Neurol, Hong Kong, Hong Kong, Peoples R China
[3] Univ Glasgow, Div Cardiovasc & Med Sci, Glasgow, Lanark, Scotland
关键词
D O I
10.1017/S1092852900008476
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Although modern community-based studies have shown that a majority of people with newly diagnosed epilepsy will enter long-term remission, seizures remain refractory to treatment in a substantial proportion of this population-perhaps as much as 40%. A consensus is being reached that, for operational purposes, pharmacoresistance can be suspected when two appropriately chosen, well-tolerated, first-line antiepileptic drugs (AEDs) or one monotherapy and one combination regimen have failed due to lack of efficacy. Poor prognostic factors include lack Of response to the first AED, specific syndromes, symptomatic etiology, family history of epilepsy, psychiatric comorbidity, and high frequency of seizures. These observations suggest that prognosis can often be determined early in the course of the disorder. We propose a management paradigm that aims to maximize the chance of successful AED therapy, including the early use of "rational polytherapy" for patients not responding to monotherapy, and to identify efficiently patients suitable for "curative" resective surgery, in particular those with mesial temporal lobe epilepsy. An orderly approach to each epilepsy syndrome will optimize the chance of perfect seizure control and help more patients achieve a fulfilling life.
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页码:110 / +
页数:10
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