成人てんかんの最新治療戦略

Treatment Strategy for Adult Epilepsy: A Current Approach

新規抗てんかん薬の単剤使用が認められ，成人てんかん患者の治療戦略は大きく変化している。新規薬は薬効の点で従来薬に勝るわけではないが，副作用が少なく，薬物相互作用がない点で優れている。従来薬の長期投与に伴い問題となる骨代謝・脂質代謝への影響がないのも利点である。特に高齢者や妊娠可能女性への使用が強く推奨される。てんかん治療の最終目標である「副作用のない発作消失」を維持するために欠かせない選択肢である。

Abstract

The current treatment strategy for adult epilepsy will change significantly in the near future after monotherapy as well as adjunctive therapy using new antiepileptic drugs (AEDs), which have been approved. These new AEDs have unique mechanisms of action with or without a broad spectrum. They have advantages of fewer adverse effects, including central nervous system manifestations and teratogenicity, and fewer or no pharmacokinetic drug interactions, although they lack enhanced efficacy compared to the current AEDs. In addition, the new AEDs do not result in adverse effects associated with the long-term use of the previous AEDs, such as osteoporosis and hyperlipidemia. The use of new AEDs is particularly recommended for elderly patients and young women with epilepsy. Further, their use does not result in seizures or cause adverse effects, which is the goal of epilepsy treatment.