国际兽医癫痫工作组共识建议：欧洲犬癫痫的药物治疗

Sofie F.M. Bhatti1*, Luisa De Risio2 , Karen Muñana3 , Jacques Penderis4 , Veronika M. Stein5 , Andrea Tipold5 , Mette Berendt6 , Robyn G. Farquhar7 , Andrea Fischer8 , Sam Long9 , Wolfgang Löscher10, Paul J.J. Mandigers11, Kaspar Matiasek12, Akos Pakozdy13, Edward E. Patterson14, Simon Platt15, Michael Podell16, Heidrun Potschka17, Clare Rusbridge18,19 and Holger A. Volk20 

Background

背景

In Europe, the number of antiepileptic drugs (AEDs) licensed for dogs has grown considerably over the last years. Nevertheless, the same questions remain, which include, 1) when to start treatment, 2) which drug is best used initially, 3) which adjunctive AED can be advised if treatment with the initial drug is unsatisfactory, and 4) when treatment changes should be considered. In this consensus proposal, an overview is given on the aim of AED treatment, when to start long-term treatment in canine epilepsy and which veterinary AEDs are currently in use for dogs. The consensus proposal for drug treatment protocols, 1) is based on current published evidence-based literature [17], 2) considers the current legal framework of the cascade regulation for the prescription of veterinary drugs in Europe, and 3) reflects the authors’ experience. With this paper it is aimed to provide a consensus for the management of canine idiopathic epilepsy. Furthermore, for the management of structural epilepsy AEDs are inevitable in addition to treating the underlying cause, if possible.

在欧洲，获得许可的犬用抗癫痫药物(AEDs)的数量在过去数年里有了相当大的增长。但是仍然存在类似的问题，包括：1）什么时候开始治疗，2）最初使用哪种药物最好，3）如果使用初始药物治疗效果不理想，可以建议使用哪种辅助抗癫痫药物,  4）什么时候应考虑改变治疗方法。在本共识建议中，概述了抗癫痫药物治疗的目的，什么时候开始犬癫痫的长期治疗，以及目前有哪些兽医用抗癫痫药物用于犬类。关于药物治疗方案的本共识的建议，1）基于当前已发表的循证文献，2)考虑了欧洲兽药处方级联监管的现行法律框架，3)反映了作者们的经验。本文旨在为犬特发性癫痫的治疗提供一个共识。此外，对于结构性癫痫的管理，除了治疗潜在的原因，如果可能的话，抗癫痫药物是难免需要使用的。

At present, there is no doubt that the administration of AEDs is the mainstay of therapy. In fact, the term AED is rather inappropriate as the mode of action of most AEDs is to suppress epileptic seizures, not epileptogenesis or the pathophysiological mechanisms of epilepsy. Perhaps, in the future, the term anti-seizure drugs might be more applicable in veterinary neurology, a term that is increasingly used in human epilepsy. Additionally, it is known that epileptic seizure frequency appears to increase over time in a subpopulation of dogs with untreated idiopathic epilepsy, reflecting the need of AED treatment in these patients [63].

目前，毫无疑问，抗癫痫药是主要的治疗手段。事实上，抗癫痫药物（antiepileptic drugs AEDs）这个词并不恰当，因为大多数抗癫痫药物的作用方式是抑制癫痫性抽搐发作，而不是致痫灶或癫痫的病理生理机制。也许，在未来，抗抽搐发作药物（anti-seizure drugs）这个术语可能更适用于兽医神经学，这个术语越来越多地用于人类癫痫。此外，据了解，在未经治疗的特发性癫痫犬亚分类群体中，癫痫性抽搐发作频率似乎随着时间的推移而增加，这反映了这些病患需要抗癫痫药治疗[63]。

In our consensus proposal on classification and terminology we have defined idiopathic epilepsy as a disease in its own right, per se. A genetic origin of idiopathic epilepsy is supported by genetic testing (when available) and a genetic influence is supported by a high breed prevalence (>2 %), genealogical analysis and /or familial accumulation of epileptic individuals. However in the clinical setting idiopathic epilepsy remains most commonly a diagnosis of exclusion following diagnostic investigations for causes of reactive seizures and structural epilepsy.

在关于分类和术语的共识中，我们将特发性癫痫（idiopathic epilepsy）本身定义为一种疾病。特发性癫痫的遗传起源可通过基因检测得到支持(如果有的话)，而基因性影响可通过高品种患病率(> 2%)、族谱分析和/或癫痫性个体的家族积累而得到支持。然而，在临床上，癫痫的原因除了反应性抽搐发作和结构性癫痫，最常见的仍然是特发性癫痫。