文档介绍：抗癫痫药恶化癫痫发作
Antiepileptic Drug-Induced Aggravation of Seizures
CD
中山大学附属第一医院神经科周列民
抗癫痫药物恶化发作 Ed。囈四睥说
癫痫发作加重的相关因素
placebo (n = 310); gray bars = levetiracetam (n = 589).
Any increase
>100% increase
0
Placebo 1000mg 2000mg 3000mg
n = 310 n = 203 n = 105 n = 281
Figure 7. Dose-response data for levetiracetam. Percentages refer to patients experiencing at least a 100% increase in seiziuvs. There teas no dose-response effect (p = ).
Levetiracetam加重发作及与剂量相关分析
SCQ)一-Ed %
swged 求
o
2
9
2
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0 8 6 4 2
Ernest R. Somerville, FRACP. Neurology 2002;59:79
Aggravation of Partial Seizures by Antiepileptic Drugs
Lamotrigine加重发作
The authors describe a paradoxical reaction to LTG)\ treatment in a patient with idiopathic rolandic epilepsy characterized by seizure deterioration, the appearance of new seizure type, and transient cognitive impairment. This phenomenon was present at a low dose after a slow titration and promptly reverted on LTG discontinuation. This rare event may have similarities with carbamazepine-induced seizure worsening caused by the Na++channel inhibitory effect of the two antiepileptic drugs.
Cerminara, Caterina et al. Neurology 2004;63(2):373
Lamotrigine加重发作
Pre-therapy with LTG
Therapy with LTG
Aggravation of Partial Seizures by Antiepileptic Drugs
Cerminara, Caterina et al. Neurology 2004;63(2):373
抗癫痫药恶化癫痫发作
AEDs which may aggravate some epileptic syndromes (ll/ll)
Drug
Syndrome
Possible worsening
Vigabatrin
Absence epilepsy Epilepsies with myoclonus
Absences
Myoclonus
Gabapentin
Absence epilepsy Epilepsies with myoclonus
Absences
Myoclonus
Lamotrigine
Severe myoclonic epilepsy Juvenile myoclonic epilepsy
At high dosage
Myoclonic seiz., GTCs
抗癫痫药恶化癫痫发作
抗癫痫药物可以加重或诱导发作吗? 如何才能确认？
这一现象常见吗？哪些药物更常见? 丙戊酸可引起发作恶化吗？
产生这一现象的机制如何？
如何才能预防和管理？
抗癫痫药物恶化发作
丙戊酸与药物恶化发作
• 99例患者来自20篇不同文献报道
•除8例增加失神发作频率无特殊背景条件外，余91例均发生在特定的条件下：线粒体肌病、脑病、乳酸中毒、肝脏病、急性和慢性脑病、高氨血症、药物相互作用、药物过量
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