てんかん診療の進歩と課題

Progress and Challenges in Epilepsy Treatment

脳神経内科が本邦で誕生後60年以上が経過し，成人てんかん診療に重要な役割を果たしている。てんかん学用語は，国際抗てんかん連盟の用語が本邦でも使われており，側頭葉てんかんなどでみられる発作は，精神運動発作から複雑部分発作，そして現在では焦点意識減損発作と変遷してきた。抗てんかん発作薬は，第2，3世代の薬剤が登場し，ファーストライン薬も変わってきている。妊娠中に比較的安全性の高い薬剤が登場している。高齢者のてんかんの治療・研究が進歩している。てんかん外科治療も進歩しているが，まだ十分に普及はしていないのが現状である。今後も脳神経内科医のてんかん診療への貢献が期待される。

Abstract

Neurologists have played an important role in the treatment of adult epilepsy for more than 60 years since the establishment of the Japanese Society of Neurology. The terminology used in epileptology in Japan is adopted from that used by the International League Against Epilepsy. The terminology for seizures observed in temporal lobe epilepsy has transitioned from psychomotor to complex partial and currently to focal impaired awareness seizures. Second- and third-generation anti-seizure medications (ASM) are currently available, and several new first-line agents have emerged in clinical practice. ASM that are relatively safe for the fetus during pregnancy are currently available, and advances have been made in research and treatment of epilepsy in the elderly population. Although surgical treatment for epilepsy is advancing, it is not widely performed in Japan. We hope that neurologists continue to contribute to epilepsy care.