抗癫痫药物与癫痫患者的意外猝死:最新综述。

IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY CNS drugs Pub Date : 2024-10-01 Epub Date: 2024-08-07 DOI:10.1007/s40263-024-01112-0
Anemoon T Bosch, Josemir W Sander, Roland D Thijs
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引用次数: 0

摘要

癫痫意外猝死(SUDEP)是大多数癫痫相关死亡的原因。它主要与未经目击的夜间惊厥(从局灶到双侧或全身强直阵挛发作(TCS))有关。由于基本机制尚不清楚,目前还缺乏有针对性的预防策略。抗癫痫药物(ASMs)通过减少癫痫发作来调节 SUDEP 风险,但个别 ASMs 或其他药物是否也会影响 SUDEP 的内部级联尚未确定。癫痫发作检测设备(SDD)可提供一种替代策略,防止三联征(TCS)在无人目击的情况下发生。在此,我们对 ASM、非癫痫伴随药物和 SDD 对 SUDEP 发生的影响的现有证据进行了严格评估。我们没有发现任何有力的证据表明,开始使用 ASMs 会对 TCS 控制以外的 SUDEP 产生影响,但我们发现一些迹象表明,多药治疗具有保护作用。我们没有发现任何迹象表明特定的 ASM 会对 SUDEP 产生风险。一项研究表明,左乙拉西坦可能具有保护作用,这需要进一步调查。只有少数几项小型研究探讨了非癫痫并发症药物与 SUDEP 之间的关联,其中精神药物没有一致的影响,而一项更广泛的研究表明他汀类药物使用者的风险较低。我们只发现了间接证据表明加强夜间监护具有保护作用,而没有明确探讨 SDD 对 SUDEP 发生的影响。我们需要进一步开展工作,探索 ASM 和其他干预措施在调节 SUDEP 风险方面的潜力,并应准确考虑 TCS 频率、多重用药情况和不依从性指标。
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Antiseizure Medications and Sudden Unexpected Death in Epilepsy: An Updated Review.

Sudden unexpected death in epilepsy (SUDEP) is responsible for most epilepsy-related deaths. It is mainly related to unwitnessed nocturnal convulsions, either focal to bilateral or generalised tonic-clonic seizures (TCS). Targeted preventive strategies are currently lacking as underlying mechanisms are largely unknown. Antiseizure medications (ASMs) modulate SUDEP risk through seizure reduction, but it is yet undetermined whether individual ASMs or other medications could also influence the internal SUDEP cascade. Seizure detection devices (SDD) may offer an alternative strategy by preventing TCS from being unwitnessed. Here, we critically evaluated the current evidence on the influence of ASMs, non-epilepsy concomitant drugs and SDD on SUDEP occurrence. We found no robust evidence for the effect of starting ASMs on SUDEP beyond TCS control, but we found some indications of a protective effect for polytherapy. We found no signs that specific ASMs exert a risk for SUDEP. One study suggested a possible protective effect of levetiracetam requiring further investigation. Only a few small studies addressed the association between non-epilepsy concomitant drugs and SUDEP, with no consistent effect for psychotropic medications and one more extensive study suggesting a lower risk among statin users. We only found indirect evidence indicating a protective effect for enhancing nocturnal supervision without explicitly addressing the impact of SDD on SUDEP occurrence. Further work is needed to explore the potential of ASMs and other interventions to modulate SUDEP risk, and they should accurately account for TCS frequency, polypharmacy and markers of non-adherence.

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来源期刊
CNS drugs
CNS drugs 医学-精神病学
CiteScore
12.00
自引率
3.30%
发文量
82
审稿时长
6-12 weeks
期刊介绍: CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes: - Overviews of contentious or emerging issues. - Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses. - Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. - Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry. - Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.
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