抗癫痫药物的选择 课件.pptVIP

Best first AED 婴儿癫痫有时不可能区分是否为部分性或全面性 Eg: Dravet’s syndrome ( severe myoclonic epilespy of chiildhood) usually presents with hemiconvulsion. Infantile spasm: Pattern can change from generalised to partial seizures Best first AED 疗效: 如果痫性发作无法分型或分类 Valproate, lamotrigine or topiramate, Levitiracetum Best first AED 耐受性: Valproate Carbamazepine are better tolerated than Pheno or phenytoin 方便性; Newer AEDs are costly compared older ones Newer AEDS 新药的真正优势? 是否可以替代传统药物? 新药的高价格是否提示具有高疗效? 我们如何应用新药? Newer drugs No 疗效 主要区别在于副作用 另一区别是药物的相互作用 Drug choice should be tailored to the patient 可用于部分性癫痫的新型AEDs Lamotrigine拉莫三嗪, Oxcarbazepine奥卡西平, Clobazam氯巴占, Gabapentin加巴喷丁 and Topiramate妥泰 疗效与卡马西平或苯妥英相当 新药的耐受性 Gabapentin Levetiracetum Lamotrigine Oxcarbamazepine Tiagabine Topiramate Vigabatrin 耐受性好 治疗中止率高 对认知的影响 Levetiracetum Lamotrigine Tiagabine 无显著差异 药物起效时间? 稳态时间 AEDs达稳态的时间 药物 半衰期 稳态时间 Phenytoin 15-30 hrs 5-15 days Carbamazepine 11-17 hrs 3-5 days Valproate 6-18 hrs 2-4 days Oxcarbamazepine 8-10 hrs 3-4 days Lamotrigine 10-15 hrs 5-15 days Topiramate 20-24 hrs 5 days Levetiracetum 7-8 hrs 2-3 days Gabapentin 5-7 days 1-2 days 不恰当的药物选择与癫痫发作 Wrong selection of drugs can worsen seizure 药物 综合征 Carbamazepine Absence epilepsy Juvenile myoclonic epilepsy Progressive Myoclonus E. Phenytoin Absence epilepsy Progressive Myoclonus E Phenobarbitone Absence epilepsy Benzodiazepines Lennox-Gastaut syndrome AEDs可导致加重的癫痫综合征 药物 综合征 Vigabatrin Absence epilepsy Epilepsies with myoclonus Gabapentin Absence epilepsy Epilepsies with myoclonus Lamotrigine Severe myoclonic epilepsy Juvenile myoclonic epilepsy AEDs可导致加重的癫痫综合征 单药治疗的初始选择 特发性全面性癫痫 （expert committee） CLINICAL SITUATION GTCS ABSENCE S MYOCLONIC EPILEPSY Initial monotherapy Valproate Lamotrigine Topiramate Valproate Ethosuximide Lamotrigine Valproate Second monotherapy ( Valproate failure) Lamotrigine To