抗癫痫药物与心血管疾病危险因素

癫痫与心血管疾病(cardiovascular disease,CVD)互为因果,癫痫可增加CVD的发生率和死亡率,而CVD可诱发癫痫猝死。不同的抗癫痫药物对CVD危险因素的影响各异,这些危险因素包括体质量、胰岛素抵抗、代谢综合征、血清尿酸水平、颈动脉内膜中层厚度和氧化应激标志物等。鉴于部分抗癫痫药物可能增加或降低CVD发生风险,因此在实施个体化的抗癫痫治疗时,对于有较高CVD发生风险的癫痫患者应选择合适的抗癫痫药物,同时合理使用可降低CVD发生风险的药物。     

妊娠合并癫癎的研究

癫癎是神经系统常见的疾病之一。妊娠与癫癎互为影响,妊娠可影响癫癎发作,癫癎发作和抗痫药也可对妊娠妇女及胎儿产生许多不利影响。在妊娠时诊断癫癎要重视症状与既往发作史相结合。尽量选用恰当的单一抗癫癎药物,应用最低有效剂量控制癫癎发作,定期检测血药浓度,最大限度降低孕产妇及胎儿的危险。     

成年癫癎患者合并抑郁障碍的临床研究

目的研究成年癫癎患者合并抑郁障碍的主要影响因素。方法应用24项汉密尔顿抑郁量表进行测评,并对癫癎合并抑郁障碍的相关危险因素进行分析。结果癫患者抑郁障碍发生率显著高于对照组。就业状况、病程、使用抗癫癎药物治疗方式、难治性癫、合并其他疾病为癫患者合并抑郁障碍的相关危险因素。结论癫癎合并抑郁障碍的发病率高。早期诊断及治疗癫合并抑郁障碍对提高患者临床疗效及生活质量有重要意义。     

心脏病变是癫癇猝死之重要原因

癫癇猝死系指癫癇患者在发作期或发作间期突发的无法解释的死亡,其风险是普通人群的20余倍。癫癇猝死存在多种机制,与心功能的相关性研究是目前研究的重要课题。癫癇和心脏离子通道病共存的遗传易感性、自主神经功能异常、抗癫癇药物等相关因素导致的心功能异常易诱发癫癇患者发生心源性猝死,进一步了解癫癇猝死发生过程中的心脏病变相关机制能够为制定预防和治疗策略提供理论基础。     

脑卒中后癫癎发作临床研究

目的探讨脑卒中后癫癎发作的临床特点。方法选择1105例经颅脑CT/MRI证实且无癫癎史的脑卒中患者,回顾性分析患病率、危险因素、首次发作时间、发作类型、脑电图、治疗及预后。结果 4.6%患者(51/1105)出现脑卒中后癫癎发作,脑出血、蛛网膜下腔出血、皮质病灶、病灶范围>1个脑叶的脑卒中患者更易出现脑卒中后癫癎发作。迟发性癫癎患者更易出现反复癫癎发作,抗癫癎药物治疗效果良好。结论脑卒中类型、病灶位置、范围等均为脑卒中后癫癎发作的危险因素。     

部分性癫持续状态的诊治(附3例病例随访研究)

目的探讨部分性癫持续状态的诊断和治疗。方法对本院癫中心收治的3例部分性癫持续状态的诊断和抗癫药物的选择进行分析。结果托吡酯、卡马西平对于部分性癫持续状态疗效显著。结论部分性癫持续状态的诊断及鉴别诊断不仅依靠发作期的视频脑电监测,其他因素诸如以往确定的癫发作、睡眠中发作、发作间期样放电等同样重要。部分性癫持续状态的治疗要注意用药的风险和疗效平衡。口服抗癫药物的合理选择可以完全控制部分性癫持续状态。     

脑梗死后早期癫发作的临床特征及危险因素分析

目的探讨脑梗死后早期癫癎发作的临床特征并分析其危险因素。方法回顾性总结脑梗死患者早期癫癎发作的临床资料;对脑梗死后早期癫癎发作的发生率、发作时间、发作类型、脑电图、治疗转归等临床特点,应用统计学方法分析影响早期癫癎发作的危险因素。结果 425例患者中,早期癫癎发作39例(9.18%);首次发作多出现于梗死发病1 d以内(46.15%);发作类型以全身强直阵挛发作多见(43.59%)。37例患者经观察处理后癫癎发作终止或明显缓解。单因素分析显示皮质脑梗死、心源性脑栓塞、美国国立卫生研究院卒中量表(NIHSS)≥15分、电解质紊乱显著增加早期癫癎发作风险(P0.05);多因素Logistic分析显示梗死部位累及皮质和心源性脑栓塞为早期癫癎发作的独立危险因素(P0.05)。结论脑梗死后早期癫癎发作并不罕见,全面强直阵挛发作为主要发作类型,大多数患者经观察处理后可缓解;皮质部位梗死及心源性脑栓塞可增加脑梗死后早期癫癎发作的风险。     

脑外伤后癫(癎)的临床研究进展

外伤后癫(posttraumaticepilepsy,PTE)是脑外伤(traumaticbraininjury,TBI)后的常见并发症,PTE的发病率为4.4%～53.0%。PTE的危险因素包括TBI的严重程度、早发性癫发作、硬脑膜的完整性等。关于PTE的预防,目前认为TBI患者在脑损伤后1周内服用抗癫药物可预防早发性癫的出现。PTE的治疗包括药物治疗和手术治疗。     

脑外伤后癫癇的临床研究进展

外伤后癫癇（posttraumati cepilepsy，PTE）是脑外伤（traumatic brain injury，TBI）后的常见并发症，PTE的发病率为4．4％-53．0％。PTE的危险因素包括TBI的严重程度、早发性癫癇发作、硬脑膜的完整性等。关于PTE的预防，目前认为TBI患者在脑损伤后1周内服用抗癫癇药物可预防旱发性癫癇的出现。PTE的治疗包括药物治疗和手术治疗。     

急性脑血管病继发性癫癎86例分析

目的研究急性脑血管病(CVD)继发癫癎的发生率、发生时间、发作类型与病灶部位的关系、治疗措施以及预后.方法选择急性脑血管病经头部CT或(和)MRI(或)和腰椎穿刺确诊.结果本组急性脑血管病1271例,发生率为6.8%(86/1271),其中脑出血9.2%(28/305),脑梗死6.0%(54/896),蛛网膜下腔出血5.7%(4/70).早发癫癎(2周内)发作80.2%(69/86),迟发癫癎(2周后发生)19.8%(17/86).在脑血管病急性期继发癫癎的多不需长期抗癫癎治疗,而在恢复期和后遗症期继发癫癎的多需长期抗癫癎治疗.CVD继发癫癎的死亡率明显增高(33.7%).结论急性脑血管病继发癫癎的发生率6.8%.80.2%在2周内发生.脑出血继发癫癎多表现为大发作,脑梗死多表现为部分发作.脑血管病继发癫癎的死亡率明显增高.     

The effects of antiepileptic drugs on vascular risk factors: A narrative review

PurposeEpilepsy is associated with increased cardiovascular disease (CVD) morbidity and mortality. The exact causes of this link are not clearly defined. The role of antiepileptic drugs (AEDs) in influencing CVD risk in patients with epilepsy remains controversial. A link between epilepsy, AEDs and cardiac arrhythmias has been proposed and may be responsible for sudden unexpected death in epilepsy (SUDEP).MethodsWe searched MEDLINE up to December 1, 2013 for relevant publications using combinations of keywords. We also examined the reference list of articles identified by this search and selected those we judged relevant. These were included in this narrative review.ResultsAEDs may exert both beneficial and adverse cardiovascular effects. This narrative review considers the influence of AEDs on some predictors of vascular risk [i.e. weight, insulin resistance, metabolic syndrome, lipids, lipoprotein (a), C-reactive protein, homocysteine, vitamins, coagulation factors, uric acid, carotid intima media thickness, markers of oxidative status and matrix metalloproteinase-9]. Certain AEDs can also have pro-arrhythmic properties.ConclusionsAEDs may exert different effects on various established and emerging predictors of vascular risk. Furthermore, pharmacokinetic interactions between AEDs and drugs used to reduce vascular risk (e.g. statins) need to be better documented.Whether this knowledge, in terms of individualizing antiepileptic and CVD prevention treatment, will prove to be relevant in clinical practice remains to be established.     

Do antiepileptic drugs accelerate forgetting?

The majority of patients with epilepsy become seizure-free with antiepileptic drug therapy. However, seizures in approximately one-third of patients with epilepsy are difficult to treat with antiepileptic drugs and require high doses or polytherapy. High dosages increase the risk of cognitive side effects. We retrospectively investigated 162 patients with refractory temporal lobe epilepsy to determine whether the antiepileptic drugs carbamazepine, phenobarbital, and phenytoin affect the acquisition and retention of verbal and visual information. We found that patients with high serum levels of these antiepileptic drugs were selectively impaired in the retention but not acquisition of new information. Intelligence, age, duration of epilepsy, and seizure frequency were controlled for and were not factors in the observed results. There were no differences in favor of a certain drug with respect to memory functioning. Our results suggest that patients with refractory epilepsy with high serum levels of the antiepileptic drugs studied are at higher risk of accelerated forgetting.     

Women and epilepsy: review and practical recommendations

Individuals with epilepsy experience a number of sex-specific problems. In women, pregnancy and delivery are obvious issues, fertility problems are more often encountered and they also seem to have a higher frequency of sexual problems. A large number of women with epilepsy experience seizure exacerbation in relation to the menstrual cycle and have higher frequencies of menstrual disturbances and polycystic ovaries. Cosmetic problems affecting skin, hair or weight may also be drug induced. The use of antiepileptic drugs may influence the effect of contraceptives leading to unplanned pregnancies and contraceptives may affect the serum levels of antiepileptic drugs. The care of pregnant women with epilepsy requires attention to a number of guidelines and close cooperation between neurologist and gynecologist is recommended. Although the majority of the women with epilepsy experience normal pregnancies and deliveries, their children have a higher risk of birth defects. At menopause, their seizure pattern may change and some antiepileptic drugs may increase the risk of osteoporosis. The optimal treatment of women with epilepsy should take into account these gender-specific issues in the different stages of life.     

Epilepsy therapy: issues for women and men

It has been suggested that polycystic ovary syndrome is a common finding in women treated with valproate. However, in a recent study this suggestion could not be confirmed. There is currently no clear evidence that valproate contributes to the development of the polycystic ovary syndrome. Focal epileptic discharges may have an impact on the hypothalamic-pituitary-ovarian or -testicular axis. In the case of successful epilepsy surgery the impact of epilepsy on endocrine functioning may cease. This may lead to a normalization of disturbed menstrual cycles in women, and leads to a post-surgical increase of serum androgens in men. Both findings are supplemented by the results of animal experiments. Children exposed to antiepileptic drugs during pregnancy show a normal psychomotor and cognitive development. However, newly developed as well as traditional antiepileptic drugs increase the risk that a child exposed to these drugs during pregnancy will develop a malformation.     

Use of psychotropic drugs in patients with epilepsy: interactions and seizure risk

It is now accepted that patients with epilepsy are more prone than the general population to develop psychiatric disorders, being significantly at risk due to psychosocial reasons, the presence of electrophysiologic and anatomopathologic abnormalities mainly in the limbic system, and because they are taking antiepileptic drugs which may have negative psychotropic effects. It is also known that many patients with epilepsy sometimes receive psychotropic medications on account of their psychiatric symptoms. This review focuses on the main problems that a clinician may encompass when treating psychiatric disorders in patients with epilepsy. On one hand, the effects of antiepileptic drugs on mood and behavior for a correct differential diagnosis of psychiatric symptoms. On the other hand, the main factors that may affect choice of therapy, patients' response and compliance, when prescribing antidepressants or antipsychotic drugs, drug interactions and the potential proconvulsive risk are reviewed.     

Ist Epilepsie eine progrediente Erkrankung?

There is increasing evidence from both experimental and clinical studies that some types of epilepsy, particularly mesial temporal lobe epilepsy, are progressive disorders. Progressive features may be characterized by more frequent or more severe seizures, leading to development of chronic epilepsy with decreased responsiveness to treatment with antiepileptic drugs. The individual factors determining whether an epilepsy exhibits progressive features or not are not known in sufficient detail. By using of sensitive neuroimaging techniques, it was recently shown that prolonged or frequent seizures, if not pharmacologically suppressed, can progressively induce lesions in the brain. Experimental studies demonstrated that the repeated occurrence of seizures induces a variety of morphologic and functional changes in the brain which most likely underlie the chronicity of epilepsy. From these observations one may conclude that early pharmacological suppression of seizures after onset of epilepsy reduces the risk of development of chronic epilepsy. However, both experimental and clinical data indicate that epilepsy may chronify despite early treatment, meaning that currently available antiepileptic drugs do not prevent progression of epilepsy. A major goal in future epilepsy research is the enhanced understanding of factors that determine whether epilepsy will or will not exhibit progressive features in a given patient. Various patient-related, disease-related and treatment-related factors are currently discussed in this respect. It remains to be determined whether better understanding of such factors will allow a more rational development of antiepileptic drugs which treat epilepsy and not only its symptoms.     

雄激素与癫痫

动物实验和临床研究均表明性激素与癫癎发作有关,比较肯定的结论认为雌激素水平升高时,可使癫癎发作的阈值降低,加剧癫癎发作;孕激素可使癫癎发作的阈值升高,减轻癫癎发作.但对雄激素与癫癎发作的关系了解甚少,关于雄激素与癫癎关系目前国内尚未见报道,国外报道它们之间的关系亦不一致.睾酮是最重要的雄激素,本文综述了睾酮的代谢和其与癫癎及抗癫癎药物之间的关系.     

Primary prevention of epilepsy in patients with different epileptogenic conditions

Epileptic seizures are a common complication of several clinical conditions affecting the CNS. In these cases, the occurrence of seizures and epilepsy may increase the functional damage provoked by the underlying epileptogenic condition and affect the patient's quality of life to a significant extent. Therefore, the search of effective means for primary prevention of seizures and epilepsy is necessary in these cases. However, the use of antiepileptic drugs for the primary prevention of seizures and epilepsy can be considered only if the ratio between efficacy, safety and tolerability of treatment is favorable, in that the advantages, in terms of seizure prevention, outweigh the disadvantages in terms of adverse effects and overall costs of treatment. In this article, the efficacy, safety and tolerability of antiepileptic drugs for the primary prevention of seizures and epilepsy are reviewed. The areas covered include: the definition of early (provoked) and late (unprovoked) seizures; knowledge of the overall risk of seizures and epilepsy in CNS disorders for which primary prevention of seizures can be attempted; rationale for the use of antiepileptic drugs for the primary prevention of epilepsy; experimental data on the antiepileptogenic properties of antiepileptic drugs; available literature findings on the prevention of early and late seizures, with specific emphasis on randomized clinical trials; and the main problems with experimental trials for the primary prevention of epileptic seizures. On this basis, practice recommendations for the primary prevention of epilepsy will be offered where indicated. Suggestions for future research are also made as concluding remarks, by indicating the areas of investigation and the design of future studies.     

Antiepileptic drugs: affective use in autism spectrum disorders

Antiepileptic drugs are widely administered to individuals with autistic spectrum disorders. There are several reasons for the use of antiepileptic drugs in autistic spectrum disorders, including the high incidence of epilepsy in these individuals, the anecdotal reports suggesting an improvement of communication and behavior in autistic subjects with epileptic discharges, and the increased awareness that some disruptive behaviors may be manifestations of an associated affective disorder. In this study, data on the current use of antiepileptic drugs in the treatment of autism, and on the association of affective disorders with epilepsy and autism, are reviewed. The evidence supporting the hypothesis that there may be a subgroup of autistic children with epilepsy and affective disorders that preferentially respond to antiepileptic drugs is still very preliminary, and further investigations with double-blind controlled studies are needed. Although the role of antiepileptic drugs at the present time is not established, there is evidence that autism, epilepsy, and affective disorders commonly co-occur, and that they may share a common neurochemical substrate, which is the common target of the psychotropic mechanism of action of different antiepileptic drugs.     

Diagnosis and management of depression and psychosis in children and adolescents with epilepsy

The neurologic dysfunction underlying epilepsy can predispose patients to psychiatric disorders, and the incidence of both depression and psychosis is increased in people with epilepsy. Depressive disorders are the most frequently recognized psychiatric comorbidities in people with epilepsy, but depression in children can be particularly difficult to recognize. Clinicians need to inquire about not only classic symptoms of depression such as anhedonia but also less obvious symptoms such as unprovoked irritability, unsubstantiated complaints of lack of love from family members, somatic complaints, and problems with concentration and poor school performance. The diagnosis of depressive disorders in children with epilepsy and mental retardation is even more difficult. Physicians need to be alert for the presence of iatrogenic depression, which may result from antiepileptic drugs or epilepsy surgery. People with epilepsy are also at increased risk for psychosis, which can be interictal, postictal, or (rarely) an expression of ictal activity. This psychosis can be related to seizure remission (ie, alternative psychosis) or iatrogenic (eg, related to antiepileptic drugs or following temporal lobectomy). Although both antidepressants and antipsychotic drugs have the potential to lower the seizure threshold and increase seizures, careful drug selection, dosing, and slow titration can minimize this risk, allowing treatment to proceed.