Adverse Effects of the Drugs for Treating Partial Seizures 不良效应
The most frequently occurring adverse effects associated with the drugs used for partial seizures relate to the CNS depression that results. The following conditions may occur: Drowsiness, fatigue, weakness, confusion, headache, and insomnia; GI depression, with nausea, vomiting, and anorexia; and upper respiratory infections. These antiepileptics can also be directly toxic to the liver and the bone marrow, causing dysfunction. The exact effects of each drug vary. All of these drugs have a black box warning about the potential for increased suicidality when on these drugs. These drugs should also be tapered when discontinued because of the risk for precipitating seizures with sudden withdrawal.
与部分性癫痫发作药物使用相差的最常见不良效应都与所导致的CNS抑制有关。下列情况可能会出现：瞌睡、疲劳、虚弱无力、意识错乱、头痛、失眠；胃肠道抑制伴恶心、呕吐和厌食；上呼吸道感染。这些抗癫痫药也可能对肝和骨髓直接产生毒性，导致功能障碍。每种药物的确切效应各不相同。但所有药物都有一个关于用药时自杀倾向增加的“黑框警示”。而且，要停止使用这些药物，也必须逐渐减少剂量，因为突然停药会有触发癫痫发作危险。
Felbamate has been associated with severe liver failure and aplastic anemia. Lamotrigine has been associated with very serious to life-threatening rashes, and the drug should be discontinued at the first sign of any rash. Patients with renal dysfunction are more likely to experience toxic effects of levetiracetam, and the dose for these patients needs to be decreased accordingly.
非尔氨酯与严重的肝衰竭和再生障碍性贫血存在相关性。拉莫三嗪与极严重的威胁生命的皮疹存在相关性，一旦看到皮疹，应立即停药。肾功能障碍患者更容易出现左乙拉西坦的毒性效应，这些患者的剂量必须相应减少。
The adverse effects most commonly seen with pregabalin are related to CNS depression —tremor, dizziness, somnolence, and visual changes. This drug does have a controlled substance rating as Category V. It can cause feelings of well-being and euphoria. Because of this, its use should be limited in patients who have a history of abuse of medications or alcohol.
普瑞巴林最常见的不良效应都与CNS抑制有关：震颤、头晕、多寐、视觉改变。作为V类药，该药并没有管制药评级。该药可产生幸福和欣快感。有鉴于此，有药物滥用或酗酒史患者应限制使用。
A reduced dose of topiramate is recommended for patients with renal impairment. The drug also has been associated with marked CNS depression. Tiagabine has also been associated with serious skin rash.
肾损害患者推荐使用减剂量托吡酯。该药也与显著的CNS抑制存在相关性。噻加宾也与严重的皮疹相关。
Vigabatrin is associated with a loss of vision, and the patient should be monitored before and during treatment. If vision changes begin to occur the drug should be stopped.
氨己烯酸与目盲相关联，治疗前及治疗期间均应监测患者。若开始出现视力变化，应停止用药。
★Vocabulary for Today ★
drowsiness – n. 瞌睡
confusion – n. 意识错乱
insomnia – n. 失眠
anorexia – n. 厌食
upper respiratory infections –上呼吸道感染
antiepileptic – n. a. 抗癫痫药(的)
black box –黑框
warning – n. 警示，警告
suicidality – n. 自杀倾向
taper – v. 逐渐减少
precipitate – v. 促成，使突然发生
withdrawal -- n. 戒断，停止
aplastic – a. 发育不全的，再生障碍的
aplastic anemia –再生障碍性贫血
tremor – n. 震颤
somnolence – n. 多寐
controlled substance – 管制药
well-being – n. 幸福
euphoria – n. 欣快
1. A 56-year-old man with long-standing epilepsy presented with gingival overgrowth, pictured here. Which of the following antiepileptic medications is responsible for this symptom?
A. Lacosamide
B. Phenytoin
C. Leviteracetam
D. Vigabatrin
E. Tiagabine 2. A 25-year-old man with epilepsy was started on a new antiepileptic medication. Though he was told to increase the dose slowly, he instead took several pills daily. He presented with the rash pictured here. Which of the following medications is most likely responsible for his condition?
A. Lacosamide
B. Phenytoin
C. Lamotrigine
D. Vigabatrin
E. Tiagabine
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答案 Answers 1. B: Phenytoin
Phenytoin is a sodium channel blocker used in the treatment of focal seizures, generalized tonic–clonic seizures, and tonic and atonic seizures. Potential side effects include gingival hyperplasia with long-term use, acne, hirsutism, cerebellar atrophy, decreased bone density, and anemia. There is also potential for allergic rash. It also reduces the efficacy of drugs metabolized by the CYP450 system (amiodarone, fluoxetine, isoniazid, etc.). 2. C. Lamotrigine
Lamotrigine (Lamictal) increases the activity of gamma-aminobutyric acid (GABA) and is a voltage-gated sodium blocker. It is used to treat focal seizures, tonic–clonic seizures, and patients with Lennox–Gastaut syndrome. It is also effective as a mood stabilizer in patients with bipolar disorder. The image is a picture of Stevens–Johnson syndrome (SJS), a life-threatening hypersensitivity reaction affecting the skin and mucous membranes. It is most closely associated with lamotrigine, and to reduce this risk, lamotrigine is titrated slowly to a therapeutic dosage. Lamotrigine is also associated with dizziness, blurred vision, diplopia, unsteadiness, and tremor, particularly at higher doses. It has one of the lowest rates of birth defects, and is often used in women of reproductive age.
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