抗癫痫药物性脑病研究进展

Progress in antiepileptic drug-induced encephalopathy

抗癫痫药物性脑病指在癫痫治疗过程中由抗癫痫药物诱发的与药物相关的脑病,为中枢神经系统毒性反应,严重者可致死亡。该病发生率低,临床表现呈非典型性,容易被忽略甚至误诊,及时明确诊断是争取合理治疗的关键。传统与新型抗癫痫药物所致脑病不尽相同,本文围绕不同抗癫痫药物性脑病的临床表现、脑电图改变、发病机制及治疗原则进行综述,发现其临床表现主要为神经系统受累的症状,其中丙戊酸钠脑病、托吡酯脑病、唑尼沙胺脑病、吡仑帕奈脑病以高血氨脑病最为常见,卡马西平脑病可表现为后部可逆性脑病综合征,苯妥英钠脑病可表现为小脑综合征。脑电图改变以背景活动减慢、放电波形增加为主,缺乏特异性。发病机制与药物本身的作用机制相关,其中奥卡西平与拉莫三嗪可通过阻滞钠通道发挥作用,唑尼沙胺、托吡酯、丙戊酸钠、吡仑帕奈之间相互作用引起血氨显著升高。治疗原则以抑制吸收、促进排泄和对症治疗为主,预后较好。

Antiepileptic drug-induced encephalopathy refers to the drug-related encephalopathy induced by antiepileptic drugs in the process of epilepsy treatment.Antiepileptic drug-induced encephalopathy is a central nervous system toxic reaction and can cause death in severe cases.Given that the incidence of the disease is low and the clinical manifestation is atypical.It can be easily ignored or even misdiagnosed.Therefore,timely and clear diagnosis is the key for proper treatment.traditional and new antiepileptic drugs induce encephalopathy differently.This paper summarizes the clinical manifestations,EEG changes,pathogenesis and treatment principles of different antiepileptic drug encephalopathy.The main clinical manifestations are symptoms of nervous system,among which valproate encephalopathy,topiramate encephalopathy,zonidamide encephalopathy and perampanel encephalopathy are the most common;carbamazepine encephalopathy can be manifested as posterior reversible encephalopathy syndrome;phenytoin encephalopathy can be manifested as cerebellar syndrome.The EEG changes were dominated by slower background activity and increased firing waveform,lacking specificity.The pathogenesis is related to the mechanism of action of the drug itself,in which oxcarbazepine and lamotrigine can act through blocking sodium channels,and the interaction between zonisamide,topiramate,valproate and perampanel causes a significant increase in blood ammonia.The principle of treatment is to inhibit absorption,promote excretion and symptomatic treatment,with a better prognosis.