小儿癫痫治疗的安全性课件.ppt

小儿抗癫痫药物治疗的安全性Adverse Effects of Antiepileptic Drugs in Children;临床流行病学;预后 - benign epilepsies 20-30% - pharmacosensitive epilepsies 30% - pharmacodependent epilepsies 20% - pharmacoresistant epilepsies 13-20% 长期缓解: 早期（3M）对药物治疗有效 原发性/隐原性:症状性=3:1;Determinants of outcome in childhood epilepsyP. Wolf, Acta Neurol Scand 2005: 112 (Suppl. 182): 5–8;Acta Neurologica Scandinavica?112?(s181),?52-56. 2005;Cognitive problems related to epilepsy syndromes, especially malignant epilepsies. K. van Rijckevorsel Seizure (2006) 15, 227—234;1840 1860 1880 1900 1920 1940 1960 1980 2000 ;理想的抗癫痫药物 Idea AED;Tracy Glauser, Epilepsia, 47(7):1094–1120, 2006;;AEDs不良反应的分类 Table?1?A classification of adverse effects caused by AEDs;Table?2?Examples of adverse effects of AEDs in the first three categories;中枢神经系统介导的不良反应 非中枢性不良反应 皮肤、结缔组织 造血系统 肝脏与消化系统 肾脏 代谢 内分泌 周围神经系统 ;皮肤与结缔组织Integument and Connective Tissue Effects ;皮 疹Benign Skin Rashes;高敏综合征AED Hypersensitivity Syndrome;Stevens-Johnson Syndrome;;中毒性表皮松解坏死Toxic Epidermal Necrolysis;其他皮肤及结缔组织Other Skin and Connective Tissue Disorders;造血系统作用Hemopoietic System Effects;骨髓抑制少见：PHT，PB，VPA VPA：血小板减少、抑制血小板聚集、降低纤维蛋白原等，与剂量相关 血小板减少的危险因素：VPA血药浓度： 110 mg/L in women 134 mg/L in men 急性脑损伤时应用i.v VPA 死亡率 i.v PHT ;肝脏与消化系统Hepatic and Digestive System Effects;芳香类AEDs（CBZ，PHT，PB）可引起严重肝毒性，但少见（1/3000），多在高敏综合征时 VPA或VPA与其他AEDs合并使用时，注意高氨血 CBZ，FEM，ESX，VPA恶心、呕吐、消化不良通常与剂量有关，常出现在开始用药初期;肾脏影响Renal Effects;代谢、内分泌影响Metabolic and Endocrine Effects;周围神经系统Peripheral Nervous System Effects;French JA et al. Efficacy and tolerability of the new antiepileptic drugs I: treatment of new-onset epilepsy. Neurology 2004;62:1252–60. *Children only or predominantly children. ;Comparison of the efficacy and tolerability of new antiepileptic drugs: what can we learn from long-term studies?Zaccara G, Acta Neurol Scand 2006: 114: 157–168.;;Sander JW. Acta Neurol Scand 2005: 112 (Suppl. 181): 26–29 ;Topiramate: