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目的对有关7种用以治疗儿童和成人部分性和全面性难治性癫癎的新型抗癫癎药物(AEDs):加巴喷丁(gabapentin, GBP)、拉莫三嗪(lamotrigine,LTG)、托吡酯(topiramate,TPM)、噻加宾(tiagabine,TGB)、奥卡西平(oxcarbazepine,OXC)、左乙拉西坦(levetiracetam,LEV)和唑尼沙胺(zonisamide,ZNS)的药力(efficacy)、耐受性和安全性进行评估。方法由23位成人神经病学家、小儿神经病学家、癫癎病学家和药理学家组成的专家组,依据从1987年到2002年9月Medline,Current Contents和Cochrane上发表的相关文献和2003年以前的指南提供的证据进行循证医学评估。结果所有新型抗癫癎药物都适用于成人难治性部分性癫癎的添加治疗,加巴喷丁对混合性癎性发作有效,加巴喷丁、拉莫三嗪、托吡酯和奥卡西平对儿童难治性部分性癫癎有效。有限的证据还表明,拉莫三嗪和托吡酯对成人和儿童特发性全面性发作和Lennox-Gastaut综合征的添加治疗也有效。结论抗癫癎药物的选择要考虑癫癎发作和/或癫癎综合征的类型、患者的年龄、合用的药物、药物的耐受性、安全性和药力等因素。循证医学评估结果提供了难治性癫癎患者的抗癫癎药物应用指南,但尚需更为有力的证据用以鉴定其在癫癎型或综合征中疗效。
OBJECTIVES: To evaluate the efficacy and safety of 7 novel anti-epileptic drugs (AEDs) for the treatment of partial and complete refractory epilepsy in children and adults: gabapentin (GBP), lamotrigine (LTG), topiramate topiramate (TPM), tiagabine (TGB), oxcarbazepine (OXC), levetiracetam (LEV) and zonisamide (ZNS) Acceptance and safety assessment. METHODS: A panel of 23 expert neurologists, pediatric neurologists, epilepsy scientists and pharmacologists based on published literature from Medline, Current Contents and Cochrane from 1987 to September 2002 and 2003 The evidence provided by the guidelines of previous years was evaluated by evidence-based medicine. Results All new antiepileptic drugs were suitable for the treatment of adult refractory partial epilepsy, gabapentin was effective for mixed purulent seizures, and the effects of gabapentin, lamotrigine, topiramate and oxcarbazepine on the refractory part of children Epilepsy effective. Limited evidence also suggests that lamotrigine and topiramate are also effective in treating idiopathic generalized attacks and Lennox-Gastaut syndrome in adults and children. Conclusion The choice of anti-epileptic drugs should consider the type of epileptic seizure and / or epilepsy syndrome, the age of patients, the combination of drugs, drug resistance, safety and drug resistance and other factors. The evidence-based medical evaluation provides guidelines for the use of antiepileptic drugs in patients with refractory epilepsy, but more evidence is warranted to identify its effect in epilepsy or syndrome.