儿童原发性癫痫治疗指南(8)

儿童癫痫指南

IAP EXPERT COMMITTEE GUIDELINESDIAGNOSIS AND MANGEMENT OF EPILEPSY

TABLE I. GUIDELINE FOR NEW DRUGS IN NEW ONSET AND REFRACTORY EPILEPSYClobazam

New OnsetPartialAbsenceMyoclonicGTCRefractoryPartialAbsenceMyoclonicSpasmLGS

YesYesYesNoYes

YesYesYesYesYes

YesYesYesNoPossible

YesYesYesYesYes

YesNoNoNoNo

YesNoNoNoNo

No

LamotrigineYes (JME, CAE)

YesYesYesYes

Levateracetam

No

Topiramate

No

OxcarbazepineYes (Partial )

YesNoNoNo

TiagabineNo

TABLE II DOSES AND SIDE EFFECTS OF COMMON ANTIEPILEPTIC DrugsPhenobarbitonePhenytoinValparinCarbamazepineOxcarbazepineLamotrigineClobazamTopiramateLevateracetamTiagabine

Daily dose3-8 mg/kg5-15 mg/kg10-60 mg/kg10-30 mg/kg20-45 mg/kg0.2- 15 mg/kg0.4-1.2 mg/kg 3-9 mg/kg15-45 mg/kg0.5-2 mg/kg

Common side effects

Hyperactivity, academic deterioration, reversal of sleep cycles

Poor seizure control due to fluctuating drug levels, cosmetic side effects,hirsutism, ataxia

Nausea, vomiting, loss of appetite, weight gain, irregular menstruation, alopecia,somnolence

Drug rash, worsening seizures, rarely worsening school performanceSomnolence, vomiting (hyponatremia), seizure exacerbationDrug rash, Steven-Johnson syndrome

Behaviour changes, aggression, sleep disturbances, constipation, weight gainCognitive/language deterioration, fever, acidosis in infancyBehaviour changes

Somnolence, Seizure exacerbation

The dose should initially be 0.5 mg/kg (alone),0.2 mg/kg (with VPA), and 0.6 mg/kg (withphenobarbitone, phenytoin, carbamazepine); itshould be doubled every 2 weeks to a maximum of15mg/kg (alone) and 5mg/kg/day (with VPA) andhigher when used with enzyme inducers. LTG has tobe titrated slowly to prevent rashes and StevensJohnson syndrome.Topiramate

It can be used as a second line add-on agent inrefractory partial and generalized epilepsies as wellas Lennox Gastaut syndrome(64). It maybeparticularly useful in certain syndromes like infantilespasms(69,70) and Dravet’s syndrome(71). Atpresent, its use as first line monotherapy in newlydiagnosed epilepsy is not recommended because of asignificant adverse effect profile.

It should be started at a dose of 0.5-1 mg/kg in biddoses, escalated weekly or biweekly, upto maximumof 5-10mg/kg (72); Higher doses (10-30 mg/kg) andrapid escalation (every 3 days) are considered inspecial situations (infantile spasms, statusepilepticus); however, there could be a higherincidence of adverse events with high doses.

百度搜索“77cn”或“免费范文网”即可找到本站免费阅读全部范文。收藏本站方便下次阅读，免费范文网，提供经典小说综合文库儿童原发性癫痫治疗指南(8)在线全文阅读。