教育講演
新ガイドラインを踏まえたてんかんの標準的治療と新規治療
2019 年 36 巻 4 号 p. 345-348
詳細
2019 年 36 巻 4 号 p. 345-348
The new guideline for epilepsy entitled “The clinical practice guidelines for epilepsy 2018” (Guideline 2018) was published in 2018, it updated “The clinical guidelines for the treatment of epilepsy in 2010”, aiming at standard treatments of epilepsy for all clinicians who treat epilepsy patients even if not epileptologists. The guidelines consist of two parts, the first part including the various summary of diagnosis, medical and surgical therapy, related conditions such as the status epilepticus, the psychogenic non epileptic seizures and the acute symptomatic seizures, the information providing for epilepsy patients. Second part includes systematic reviews prepared by GRADE system.
The major points of updated medical treatments are as follows : (1) Although the timing of initiation of therapy is basically after two unprovoked seizures, it may start in cases of neurological abnormality, abnormal finding of EEG, epileptogenic lesion of neuroimages, family history or elder patients. It can also start according to the social status or the willing of patients. (2) The first line treatment of generalized tonic–clonic seizures is sodium valproate, other new drugs such as lamotrigine and levetiracetam are recommended in women fitting the child–bearing age. The first line treatments of focal onset seizures are carbamazepine, lamotrigine and levetiracetam, following zonisamide and topiramate. Second line treatments for focal onset seizures are other drugs including gabapentin, lacosamide and perampanel. (3) In the elder patients with co–mobidity, lamotrigine, levetiracetam and gabapentin are recommended. In women fitting the child–bearing age, the comprehensive counseling, family planning and selection of appropriate treatment are recommended before pregnancy.
Current standard managements for epilepsy are established in Guideline 2018. In the near feature, it will be updated by the evidences of efficacy and tolerability of new drugs, such as lacosamide and perampanel, provided after 2016.
