てんかんの薬物療法

Medical Treatment of Epilepsy

てんかん治療の基本は薬物療法であるが，焦点発作・焦点てんかんと全般発作・全般てんかんでは薬剤選択が異なる。実臨床では発作型および病型を考慮し，診療ガイドラインやエキスパートオピニオンを参考にして，治療薬が選択される。近年，忍容性が高い点，薬物相互作用が少ない点で優れているレベチラセタム，ラモトリギンが第一選択薬として推奨されている。ラコサミド，ペランパネルが選択される機会も増えてきている。

Abstract

Medical treatment is the primary therapy option for patients with epilepsy. Recently, the International League Against Epilepsy (ILAE) proposed that the current medications used to treat epilepsy should be referred to as ‘antiseizure medications’ (ASMs) due to the symptomatic effect exerted against seizures. The present article reviews the recent clinical practice guidelines (Clinical Practice Guidelines for Epilepsy 2018, in Japan, and the NICE guideline, published in April 2022) and expert opinions (USA, South Korea, and Spain) based on which the selection of ASMs has been discussed. The classification of seizure types and epilepsies should be examined before selecting the ASMs for each patient with epilepsy. For focal epilepsy, lamotrigine, levetiracetam, and lacosamide would be the first-line ASM, whereas, for generalized epilepsy, valproic acid, lamotrigine, and levetiracetam would be the first-line ASM. However, valproic acid is not to be prescribed to women of childbearing potential.