抗精神病类药物与癫痫发作的研究进展  

Research progress of antipsychotic drugs and seizure

作　　者：薛慧慧 岳伟[2] XUE Huihui;YUE We(College of Neurosurgery and Neurorehabilitation,Tianjin Medical University,Tianjin 300070,China;Department of Neurology,Tianjin Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]天津医科大学神经内外科及神经康复临床学院,天津300070 [2]天津市环湖医院神经内科,天津300350

出　　处：《世界临床药物》2023年第11期1232-1237,共6页World Clinical Drug

摘　　要：抗精神病药物诱发癫痫发作(epileptic seizure)是临床应用过程中需关注的问题。现有证据显示,第1代抗精神病药物诱发癫痫发作的风险较低,但氯丙嗪(chlorpromazine)除外;第2代抗精神病药物中氯氮平(clozapine)诱发癫痫发作的风险最高,而奥氮平(olanzapine)、利培酮(risperidone)、喹硫平(quetiapine)、齐拉西酮(ziprasidone)及阿立哌唑(aripiprazole)风险较低。多种因素会影响抗精神病药物诱发癫痫发作的阈值,例如癫痫发作史、同时服用其他降低发作阈值的药物、合并其他慢性疾病(如器质性脑部疾病)、个体易感性及年龄等,其中抗精神病药物血药浓度与癫痫发作次数的增加关系最为密切。为减少癫痫发作,抗精神病药物起始治疗阶段应从小剂量开始缓慢滴定,监测血药浓度,并保持在最低有效剂量。服用抗精神病药物期间可伴随脑电图改变,但脑电图异常率与癫痫发作风险关系并不明确。虽然大量证据表明抗精神病药物可降低癫痫发作阈值,但部分抗精神病药也可以发挥抗癫痫作用。该文对既往探讨抗精神病药物与癫痫发作相关文献作简要综述。Epileptic seizure induced by antipsychotic drugs is a problem that needs attention in clinical use.Current evidence shows that the risk of seizure induced by first-generation antipsychotics is low,except chlorpromazine.Among second-generation antipsychotics,clozapine has the highest risk of seizure induction,while olanzapine,risperidone,quetiapine,ziprasidone,and aripiprazole have a lower risk.Many factors influence the threshold of antipsychotic-induced seizures,such as seizure history,concomitant use of other drugs that lower the seizure threshold,comorbidity with other chronic diseases(e.g.organic brain diseases),individual susceptibility,and age,among which the antipsychotic blood concentration being most closely associated with increased seizure frequency.To reduce the risk of seizures,antipsychotic drugs should be slowly titrated from a small dose during the initial treatment stage,monitor blood drug concentrations,and maintain the minimum effective dose.Electroencephalogram changes may accompany the administration of antipsychotic medications,but the relationship between the abnormal rate of electroencephalogram and seizure risk is not clear.It is important to note that although there is substantial evidence that antipsychotics can lower seizure thresholds,some antipsychotics can also exert antiepileptic effects.Therefore,this article reviewed previous literature to explore the relationship between antipsychotics and seizures.

关 键 词：抗精神病药物 癫痫发作 脑电图 

分 类 号：R977.15[医药卫生—药品]