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引用次数: 0
摘要
耐药性癫痫(DRE)的定义是,在对两种适当的抗癫痫药物(ASM)进行充分试验后,仍无法实现对癫痫发作的持续控制。三分之一的癫痫患者会出现 DRE,并与严重的发病率和死亡率相关。新的抗癫痫药物提供的药物治疗耐受性更好,但并不一定比老的抗癫痫药物更有效。切除脑部手术是治疗 DRE 和实现癫痫发作自由的黄金标准,激光消融术是发病率较低但疗效较差的替代方法。对于不适合切除或消融的患者,多种神经调控方案可减轻癫痫发作负担。这些神经调控设备在随机临床试验中显示出相当的疗效,但在开放标签随访队列中的结果各不相同,并发症风险和相关费用也不尽相同。饮食疗法也有帮助,尤其是对小儿遗传性癫痫。目前正在研究创新的基因治疗方法,为精准医疗带来希望。
Drug-resistant epilepsy (DRE) is defined as failure to achieve sustained seizure control with adequate trials of two appropriate antiseizure medications (ASMs). DRE affects one-third of patients with epilepsy and is associated with significant morbidity and mortality. Newer ASMs provide pharmacological therapy that is better tolerated but not necessarily more effective than older ASMs. Resective brain surgery is the gold standard to treat DRE and achieve seizure freedom, with laser ablation offering an alternative with less morbidity but lower effectiveness. For patients who are not candidates for resection or ablation, multiple neuromodulation options can reduce seizure burden. These neuromodulation devices have shown comparable effectiveness in randomized clinical trials, but the results vary in open-label follow-up cohorts, as do the risks of complications and associated costs. Dietary therapies can help, particularly in pediatric genetic epilepsies. Innovative genetic therapy approaches are being pursued, offering the promise of precision medicine.
期刊介绍:
The Annual Review of Medicine, which has been published since 1950, focuses on important advancements in diverse areas of medicine. These include AIDS/HIV, cardiology, clinical pharmacology, dermatology, endocrinology/metabolism, gastroenterology, genetics, immunology, infectious disease, neurology, oncology/hematology, pediatrics, psychiatry, pulmonology, reproductive medicine, and surgery. The journal's current volume has transitioned from a gated access model to an open access model through the Annual Reviews' Subscribe to Open program. All articles published in the journal are now available under a CC BY license.