老年性癫痫的循证治疗

目的评价不同抗癫痫药物治疗方案对老年性癫痴的治疗效果及不良反应，以为老年性癫痂的循证治疗制定最佳方案。方法以elderlyepilepsy（老年性癫痫）、drugtherapy（药物治疗）、evidence．basedmedicine（循证医学）等英文词组作为检索词，分别检索PubMed、Cochrane图书馆、MEDLINE等数据库，并辅助手工检索获得临床指南、系统评价、随机对照临床试验、临床对照试验、回顾性病例分析及病例观察研究等方面的相关文献，采用Jadad量表对文献质量进行评价。结果经筛选共纳入与老年性癫痫治疗有关的临床指南1篇、系统评价14篇、随机对照临床试验1篇、临床对照试验2篇和回顾性病例分析2篇；根据Jadad量表质量评价标准，15篇为高质量文献（评分≥4分）、5篇为低质量文献（评分〈4分）。经对各项临床试验的治疗原则、不同治疗方法获得的疗效及药物安全性评价显示：（1）抗癫痂药物是治疗老年性癫痫的主要方法。（2）第二代抗癫痫药物的疗效并未优于第一代，但具有不良反应小、无药物间相互作用、安全性与耐受性高等优势。（3）一线抗癫痫药物推荐选择拉莫三嗪、左乙托西坦、加巴喷丁，其次为托吡酯和丙戊酸钠。由于受到老年性癫痫患者共患病多、长期多药治疗等因素的影响，应采取个体化治疗方案。（4）新发癫疝患者首选单药治疗，以低剂量给药、缓慢加量、延长给药间隔、改善依从性为治疗原则。结论借助循证医学的评价方法可以为老年性癫痫患者提供最佳临床证据。

Evidence-based evaluation of therapeutic measures for epilepsy in the elderly

Objective To evaluate the efficacy and adverse reactions of different drug treatment options for senile epilepsy, and to develop the best solution of the evidence- based therapy for senile epilepsy. Methods Taking elderly epilepsy, drug therapy, evidence- based medicine as search terms, retrieve in databases such as PubMed, Cochrane Library, and MEDLINE, assisted by manual searching, in order to collect relevant literature including clinical guidelines, systematic reviews, randomized controlled clinical trials, clinical controlled trials, retrospective case analysis and case observation and research. Jadad Scale was used to evaluate the quality of literature. Results Almost 20 related articles were selected including 1 clinical guideline, 14 systematic reviews, 1 randomized controlled clinical trial, 2 clinical controlled trials and 2 retrospective ease analysis. According to Jadad Scale, 15 articles were evaluated as high-quality literature （Grades I〉 4）, and the other 5 were evaluated as low-quality literature （Grades 〈 4）. Treatment principles of these ciinieal trials, efficacy of different therapies and drug safety evaluation suggest that： 1） Antiepileptie drugs （AEDs） therapy is the main treatment for elderly patients with epilepsy. 2） The second-generation AEDs are not better than the first-generation AEDs in efficacy, but have advantages such as fewer adverse reactions, little drug interactions, and higher safety and tolerability. 3） Lamotrigine, levetiraeetam and gabapentin are recominended to be first-line drugs, followed by topiramate and valproate. Influenced by multiple diseases, long- term multi- drug therapies and other factors, personalized treatment planning shall be adopted for elderly patients with epilepsy. 4） For new eases of epilepsy, monotherapy is preferred with lower dose, slow increase, longer interval between dosage and the improvement of compliance. Conclusion Evidence-based medicine can provide the best clinical evidence assessment method for elderly patients with epilepsy.