使用抗癫痫药患者的撤药问题

Problems about the withdrawal of anti-epileptic drugs

癫痫并非完全是一类终身疾病,60%~70%的患者的症状在经过一定时间的抗癫痫药治疗后能得到缓解（≥5年不发作）。癫痫缓解后考虑抗癫痫药撤药时需对患者进行综合评估、包括撤药后的癫痫复发风险及获益评估。患者长时间使用抗癫痫药可出现药物不良反应,但撤药后癫痫复发也会给患者带来负面影响。对抗癫痫药撤药的研究已有60多年的历史,但目前临床上对能撤药的条件、时机和具体方法尚无统一的标准。本文就抗癫痫药撤药的时机和速度、撤药对癫痫复发的影响及危险因素等方面的研究进展进行综述。

Epilepsy is not completely a lifelong disease, about 60% - 70% of patients can be relieved （no attack within at least 5 years） after a certain period of anti-epileptic drugs （AEDs） treatment. Making a decision to withdraw AEDs in patients with epilepsy in remission requires a careful assessment to the patients, including the associated risks and benefits. Unnecessary continuation of AEDs will expose the patients to unwarranted adverse drug reaction, however premature withdrawal with subsequent seizure recurrence may be distressing for the patients. Although it has been 60 years since researchers began studying the withdrawal of AEDs, there are still no unified standards about the time, requirements or specific methods for withdrawal. This article reviews when and how to withdraw AEDs, the effects of withdrawal on relapse, the risk factors of relapse after drug withdrawal and so on.