文档介绍：抗癫痫药物临床治疗指南新看点
NICE在治疗中
①尽可能选择单药治疗
②不推荐常规监测看癫痫药物的血药浓度
③停药原则
NICE指南
Ref: National Institute for Health and Clinical 2004; 3: 618–21
Drug Newly diagnosed epilepsy Refractory epilepsy
Partial Absence Partial Partial Idiopathic Symptomatie
mixed monotherapy generalised generalised
US UK US UK US UK US UK US UK US UK
Felbamate* No NA No NA Yes† NA Yes NA No NA Yes † NA
Gabapentin Yes§ No No No Yes Yes¶ No No No No No No
Lamotrigine Yes§ Yes|| Yes§ Yes|| Yes Yes** Yes Yes No Yes** Yes Yes**
Levetiracetam No No No No Yes Yes†† No No No No No No
Oxcarbazepine Yes Yes¶ No No Yes Yes¶ Yes Yes¶ No No No No
Tiagabine No No No No Yes Yes|| No No No No No No
Topiramate Yes§ Yes¶ No No Yes Yes** Yes§ Yes¶ Yes†† Yes††** Yes Yes**
Vigabatrin§§ NA No NA No NA Yes NA No NA No NA Yes¶¶
Zonisamide No NA No NA Yes|||| NA No NA No NA No NA
None of the drugs is recommended as first choice in newly diagnosed epilepsy by the UK guidelines (see text). NA=not available. *Patients Unresponsive to standard drugs in Whom the risk/benefit ratio supports use; † only patients >18 years; ‡ only patients >4 years with Lennox-Gastaut ayndrome; § indication not approved FDA; ¶ only patients ≥6 years; || only patients ≥12 years; ** only patients >2 years; †† only patients ≥16years; †† only generalized tonic-clonic seizures; §§ in the UK the indications are limited to adjunctive use after failure of all other appropriate drug combinations; ¶¶ only West ayndrome; |||| only adulte.
新药的严重/非严重不良事件
Lancet Neurol 2004; 3: 618–21
AED Serious adverse vevnts Nonserious adverse
Felbamate Aplastic anaemia, hepatotoxicity Gastrointestinal disturbancse, anorexia, insomnia
Gabapentin Aggresion* Weight gain, peripheral cedema, behavioural changes †
Lamotrigine Rash, including Stevens Johnson and toxic epidermal necrolysis Tics† and insomnia
(high risk for children, also more common with concomitant
vaiproic-acid use and low with slow titration); hypereensitivity
reactions, including