癫痫患者手术后撤药研究进展  

Research progress of drug-withdrawal in patients after epilepsy surgery

作　　者：顾夏颖 杨露[2] 狄晴 GU Xiaying;YANG Lu;DI Qing(The Affiliated Brain Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属脑科医院神经内科 [2]南京医科大学附属脑科医院癫痫中心 [3]不详

出　　处：《中国神经精神疾病杂志》2023年第12期753-757,共5页Chinese Journal of Nervous and Mental Diseases

摘　　要：癫痫手术是治疗耐药性癫痫的有效手段,当癫痫患者手术后达到一定时间无发作后,能否撤药成为医生和患者首要关心的问题,但癫痫手术后的药物管理目前仍缺乏明确的共识。癫痫手术后患者达到1~2年无发作后可以考虑撤药,撤药时通常每2~3个月进行一次减量,若使用多种抗癫痫发作药物(anti-seizure medications,ASMs)需逐一进行减量,且起主要作用的ASM应最后停用。手术前癫痫病程较长、手术年龄较大、术后病理为局灶性皮质发育不良、手术时未完全切除致痫灶及术后脑电图存在发作间期癫痫样放电等可能是癫痫手术患者撤药后复发的危险因素。撤药后复发患者恢复使用ASMs后预后一般较好。Epilepsy surgery is an effective treatment of drug-resistant epilepsy.Once patients became seizure free for certain period after epilepsy surgery,whether anti-seizure medications(ASMs)could be withdrawn is the primary concern of clinicians and patients.However,there is no consensus about management of anti-seizure medications in patients after epilepsy surgery.Patients after epilepsy surgery can withdraw ASMs when they become seizure free for 1 to 2 years.The dose reduction is usually done at every 2 to 3 months.For patients receiving multiple ASMs,each one should be individually tapered completely prior to the subsequent medication and the primary medication is always withdrawn in the end.Longer epilepsy duration prior to surgery,older age at surgery,patients with focal cortical dysplasia,incomplete resection of the epileptogenic zone and presence of interictal epileptiform discharges in postoperative EEG may predict the risk of seizure relapse in patients who underwent ASM withdrawal after epilepsy surgery.Patients with seizure relapse on ASM withdrawal generally have benign outcome after reinstitution of medical treatment.

关 键 词：癫痫手术 耐药性癫痫 抗癫痫发作药物 撤药 复发 危险因素 预后 

分 类 号：R742.1[医药卫生—神经病学与精神病学]