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 

翻译 By @苏苏苏苏乔

校正 By @宠物神经科医生高健  

Discontinuation of AEDs
抗癫痫药物的停减

Two main reasons for discontinuation of an AED are remission of seizures or life-threatening adverse effects.Generally, treatment for idiopathic epilepsy involves lifelong AED administration. However, remission has been reported in dogs. Remission rates between 15−30 % have been described in hospital based populations [6, 7, 47, 49]. In a study by Packer et al. (2014) 14 % of dogs were in remission on PB [84]. When ≥50 % reduction in seizure frequency was used as the outcome measure, success rates were markedly higher with 64,5 % of dogs achieving this level of seizure reduction. Several factors were associated with an increased likelihood of achieving remission, namely: being female, neutered, no previous experience of cluster seizures and an older age at onset of seizures. The same four factors were associated with an increased likelihood of achieving a ≥50 % reduction in seizure frequency [84]. The breed least likely to go into remission or have an ≥50 % reduction in seizure frequency was the Border Collie (0 and 40 %, respectively), the German Shepherd (11 and 35 %, respectively) and Staffordshire Bull Terrier (0 and 57 %, respectively) [84]. In a study by Hülsmeyer et al. (2010) the remission rate was 18 % in Border Collies independent of disease severity [49]. The decision to gradually taper the dose of an AED should be taken on a case-by-case basis, but seizure freedom of at least 1−2 years is advised. In people with prolonged seizure remission (generally 2 or more years), the decision to discontinue AED treatment is done on an individual basis considering relative risks and benefits. Individuals with the highest probability of remaining seizure-free are those who had no structural brain lesion, a short duration of epilepsy, few seizures before pharmacological control, and AED monotherapy [81, 109]. In dogs, however, little information on risk factors associated with seizure relapse exist, thus the pet owner must be aware that seizures may recur anytime during AED dose reduction of after discontinuation. To prevent withdrawal seizures or status epilepticus it is advised to decrease the dose with 20 % or less on a monthly basis.

抗癫痫药物的停减的两个主要原因是抽搐发作完全解除或用药出现危及生命的不良反应。一般来说，特发性癫痫的治疗需要终身使用抗癫痫药物。然而，有报道称有些犬的病情完全解除。据报道，在以医院为基础的群体中，解除率在15-30%之间[6,7,47,49]。Packer等人（2014）的一项研究显示，14%的犬在苯巴比妥治疗后病情解除[84]。当以抽搐发作频率降低≥50%作为结果测量时，成功率明显更高，64.5%的犬达到了这一标准的抽搐发作减少。有多个因素与病情解除的可能性增加有关，如：雌性，已绝育，以前没有丛集性抽搐发作的经历，以及癫痫发作时的年龄较大。同样的四个因素与抽搐发作频率降低≥50%的可能性增加相关[84]。最不可能解除或抽搐发作频率降低≥50%的品种是边境牧羊犬（分别为0%和40%），德国牧羊犬（分别为11%和35%）和斯塔福德郡牛头㹴（分别为0%和57%）[84]。 Hülsmeye等人（2010）的一项研究显示，边境牧羊犬的解除率为18%，与疾病严重程度无关[49]。逐渐减少抗癫痫药物剂量的决定应根据具体情况而定，但建议至少1-2年的抽搐未发作的情况下再决定。对于抽搐发作解除时间较长的人类病患（通常为2年或更长时间），停止抗癫痫药物治疗的决定应根据个人情况考虑相对风险和益处。无抽搐发作可能性最高的个体是那些没有结构性脑损伤、癫痫持续时间短、药物控制前抽搐发作少、抗癫痫药物单药治疗的个体[81,109]。然而，在犬，与抽搐发作复发相关的风险因素的信息很少，因此宠物主人必须意识到抽搐发作可能在抗癫痫药物剂量减少期间或停药后的任何时候都有可能复发。为了防止戒断性抽搐发作或癫痫持续状态，建议每月减少20%或更少的剂量来逐渐减量停药。

In case of life-threatening adverse effects, instant cessation of AED administration under 24h observation is necessary. In these cases, loading with an alternative AED should be initiated promptly in order to achieve target serum concentrations before serum PB concentration decreases. Loading with KBr (see section on KBr) or levetiracetam (see section on levetiracetam) is possible. If hepatic function is normal, starting imepitoin or zonisamide at the recommended oral starting dose may be another alternative.

如出现危及生命的不良反应，有些病例需在24小时观察下立即停用抗癫痫药物。在这些情况下，应立即开始负荷剂量给予替代的抗癫痫药物，以便在血清苯巴比妥浓度下降之前达到目标血清药物浓度。可以负荷剂量给予溴化钾（参见溴化钾一节）或左乙拉西坦（参见左乙拉西坦一节）。如果肝功能正常，以推荐的口服起始剂量开始服用伊匹妥因或唑尼沙胺，可能是另外的选择。