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 

Choice of AED therapy

抗癫痫药物治疗的选择

There are no evidence-based guidelines regarding the choice of AEDs in dogs. When choosing an AED for the management of epilepsy in dogs several factors need to be taken into account (AED-specific factors (e.g. regulatory aspects, safety, tolerability, adverse effects, drug interactions, frequency of administration), dog-related factors (e.g. seizure type, frequency and aetiology, underlying pathologies such as kidney/hepatic/gastrointestinal problems) and owner-related factors (e.g. lifestyle, financial circumstances)) [23]. In the end, however, AED choice is often determined on a case-by-case basis.

目前还没有循证的指南来指导犬如何选择抗癫痫药物。

在选择抗癫痫药物治疗犬的癫痫时，需要考虑多个因素(抗癫痫药物特异性因素(如监管方面、安全性、耐受性、不良反应、药物相互作用、给药频率)、与犬相关的因素(如抽搐发作类型、频率和病因、潜在病理如肾/肝/胃肠道问题)以及与宠主相关的因素(如生活方式、经济状况))[23]。

然而最终，抗癫痫药物的选择通常视情况而定。

Until recently, primary treatment options for dogs with epilepsy have focused mainly on phenobarbital (PB) and potassium bromide (KBr) due to their long standing history, widespread availability, and low cost. While both AEDs are still widely used in veterinary practice, several newer AEDs approved for use in people are also being used for the management of canine idiopathic epilepsy mainly as add-on treatment. Moreover, since early 2013, imepitoin has been introduced in most European countries for the management of recurrent single generalized epileptic seizures in dogs with idiopathic epilepsy.

直到最近，癫痫犬的主要治疗仍然是使用苯巴比妥（phenobarbital PB）和溴化钾（potassium bromide KBr），它们历史悠久、可用性广而且成本低。

这两种抗癫痫药物在兽医临床广泛使用的同时，也有多种获准用于人类的新型抗癫痫药也被用于管理犬的特发性癫痫，主要是作为辅助治疗。

此外，自2013年初以来，大多数欧洲国家已引入伊匹妥因（imepitoin），用于治疗特发性癫痫犬的复发性单次全身性癫痫性抽搐发作。

Several AEDs of the older generation approved for humans have been shown to be unsuitable for use in dogs as most have an elimination half-life that is too short to allow convenient dosing by owners, these include phenytoin, carbamazepine, valproic acid, and ethosuximide [119]. Some are even toxic in dogs such as lamotrigine (the metabolite is cardiotoxic) [26, 136] and vigabatrin (associated with neurotoxicity and haemolyticanemia) [113, 131, 138].

一些被批准用于人类的老一代抗癫痫药物已被证明不适合用于犬，因为大多数抗癫痫药物对于犬来说的消除半衰期太短，不能方便地让宠主给药，这些抗癫痫药物包括苯妥英（phenytoin）、卡马西平（carbamazepine）、丙戊酸（valproic acid）和乙琥胺（ethosuximide）[119]。

有些甚至对犬有毒，如拉莫三嗪（lamotrigine）（其代谢物具有心脏毒性）[26,136]和氨己烯酸（vigabatrin）（与神经毒性和溶血性贫血有关)[113,131,138]。

Since the 1990s, new AEDs with improved tolerability, fewer side effects and reduced drug interaction potential have been approved for the management of epilepsy in humans. Many of these novel drugs appear to be relatively safe in dogs, these include levetiracetam, zonisamide, felbamate, topiramate, gabapentin, and pregabalin. Pharmacokinetic studies on lacosamide [68] and rufinamide [137] support the potential use of these drugs in dogs, but they have not been evaluated in the clinical setting. Although these newer drugs have gained considerable popularity in the management of canine epilepsy, scientific data on their safety and efficacy are very limited and cost is often prohibitive.

自20世纪90年代以来，耐受性更好、副作用更少、药物相互作用可能性更低的新型抗癫痫药已被批准用于治疗人类癫痫。

许多新型药物在犬身上似乎相对安全，包括左乙拉西坦（levetiracetam）、唑尼沙胺（zonisamide）、非尔氨脂（felbamate）、托吡酯（topiramate）、加巴喷丁（gabapentin）和普瑞巴林（pregabalin）。

拉科酰胺（lacosamide）[68]和卢非酰胺（rufinamide）[137]的药代动力学研究支持这些药物在犬上的潜在应用，但尚未在临床环境中进行评估。

尽管这些新药在治疗犬癫痫方面已经获得了相当大的普及，但关于其安全性和有效性的科学数据非常有限，而且成本往往令人望而却步。