癫痫治疗的目标.pptVIP

癫痫治疗目标;前提： 准确的诊断发作类型及癫痫综合征的分类 患者病情分析；年龄、性别特点；共患病；家族史及治疗经过的相关资料 全面掌握抗癫痫药物的知识 治疗目标： 一、控制发作 二、长期治疗：提高癫痫发作阈值，改变神经网络的可塑性，达到无忧生活无发作治愈癫痫最终目标;控制发作;严重病例、特殊病例可首选新型抗癫痫药 发作类型多或发作类型不能确定宜首选广谱抗癫痫药 其他病人可采用合理的多药治疗，最大限度减少及减轻发作，避免严重的药物不良反应，尽少的影响生活质量 真正的难治性癫痫可考虑其它治疗或外科手术咨询等措施;三、药物剂量 达到S-F目标，80%患者仅需中量，95%患者剂量可稍高 成人：CBZ≤600mg/day~ ≤800mg/day VPA ≤1000mg/day~ ≤1500mg/day L.T.G ≤200mg/day~ ≤300mg/day TPM 50-400mg 一般推荐200mg/day 100mg/day时初步评估，儿童2.5-4mg/kg.day（重症例外） 药物基因学的观点 个体药物疗效的阈值;托吡酯在癫痫治疗中的地位;1840 1860 1880 1900 1920 1940 1960 1980 2000 ;托吡酯全球应用进展;近期资料;托吡酯、卡马西平和丙戊酸钠单药治疗在新诊断的癫痫中的双盲比较;托吡酯单药治疗患者6 月*无发作 ;托吡酯单药治疗新诊断患者剂量相关试验;Topiramate : Seizure Free duration;托吡酯作为广谱抗癫痫药单药治疗在临床中的应用;局灶性和全面性癫痫患者平均每月发作次数的进展情况;托吡酯治疗癫痫患者12个月长期疗效安全性研究;CONCLUSION：Topiramate long-term monotherapy in patients with epilepsy who had completed one of two previous open-label trials was associated with a high seizure-free rate and well tolerated.Low drop-out rates due to lack of efficacy suggest a persistent long-term efficacy of topiramate.;托吡酯治疗老年癫痫患者一年长期疗效安全性研究;Conclusion：Topiramate was well tolerated in the treatment of various seizure types in elderly patients with epilepsy Treatment with topiramate resulted in significant seizure reduction, seizure freedom and improvement in certain quality of life aspects;丙戊酸钠治疗后转换托吡酯治疗20周疗效安全性研究;CONCLUSION: After transition from VPA topiramate was associated with a substantial seizure reduction and few side effects. The median TPM dose was 125 mg/day.;卡马西平/奥卡西平治疗后转换托吡酯治疗26周疗效安全性研究;Conclusion：A transition from Oxcarbazepine or Carbamezepine to Topiramate was associated with a favourable tolerability profile as well as as an improved seizure control. In addition, there was a significant improvement in several quality of life aspects.;Topiramate Monotherapy ;长期治疗;四、无发作后继续治疗2-5年是否能减停治疗，要结合病情 患者的特点，脑电图，治疗后发应，药物种类、数量、药量、家长态度等综合判定。一般减量不宜过快，减量早期复发者停药困难。在减药、停药中要避免诱发因素（睡眠、应激、酗酒、其它） 要达到理想的治疗目标，需有丰富的知识，严谨的作风 正确的方法与患者充分的沟通，争取为患者