藥物治療是癲癇主要治療手段。早期選擇合適的抗癲癇發作藥物（Antiseizure medications，ASMs）對控制癲癇的發作至關重要。第三代ASM吡侖帕奈作為非競爭性α-氨基-3-羥基-5-甲基-4-異噁唑丙酸（α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid，AMPA）受體拮抗劑，通過阻斷谷氨酸（Glutamate，Glu）介導的興奮性傳遞抑制癲癇發作，目前已廣泛用于多種類型的癲癇發作。為促進其在我國成人癲癇中的更合理使用，保障臨床用藥的有效性和安全性，中國抗癲癇協會藥物治療專業委員會組織該領域專家，根據美國神經病學學會（American Academy of Neurology，AAN）/美國癲癇協會（American Epilepsy Society，AES）指南證據評級方法對研究進行評級，結合德爾菲（Delphi）法以線上問卷的形式對每一條推薦意見進行投票表決，經統計處理最終制定本共識，以供臨床使用。
Citation： 中國抗癲癇協會藥物治療專業委員會. 吡侖帕奈治療成人癲癇的中國專家共識. Journal of Epilepsy, 2024, 10(5): 373-383. doi: 10.7507/2096-0247.202406016 Copy
Copyright ? the editorial department of Journal of Epilepsy of West China Medical Publisher. All rights reserved
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- 2. Liu W, Xu Y, Lin Y, et al. Burden of epilepsy in China and its provinces, 1990 to 2019: findings from the Global Burden of Disease Study 2019. Chinese Medical Journal, 2023, 136(3): 305-312.
- 3. Yu P, Zhou D, Liao W, et al. An investigation of the characteristics of outpatients with epilepsy and antiepileptic drug utilization in a multicenter cross-sectional study in China. Epilepsy Behav, 2017, 69: 126-132.
- 4. Ding D, Zhou D, Sander JW, et al. Epilepsy in China: major progress in the past two decades. Lancet Neurol, 2021, 20(4): 316-326.
- 5. Hong Z, Qu B, Wu XT, et al. Economic burden of epilepsy in a developing country: a retrospective cost analysis in China. Epilepsia, 2009, 50(10): 2192-2198.
- 6. Mu J, Liu L, Zhang Q, et al. Causes of death among people with convulsive epilepsy in rural West China: a prospective study. Neurology, 2011, 77(2): 132-137.
- 7. 成人癲癇患者長程管理共識專家協作組. 關于成人癲癇患者長程管理的專家共識. 中華神經科雜志, 2013, 46(7): 496-499.
- 8. Kwan P, Brodie MJ. Epilepsy after the first drug fails: substitution or add-on? Seizure, 2000, 9(7): 464-468.
- 9. Hakeem H, Alsfouk BA, Kwan P, et al. Should substitution monotherapy or combination therapy be used after failure of the first antiseizure medication? Observations from a 30-year cohort study. Epilepsia, 2023, 64(5): 1248-1258.
- 10. Chen Z, Brodie MJ, Kwan P. What has been the impact of new drug treatments on epilepsy? Curr Opin Neurol, 2020, 33(2): 185-190.
- 11. Chen Z, Brodie MJ, Liew D, et al. Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs: a 30-year longitudinal cohort study. JAMA Neurol, 2018, 75(3): 279-286.
- 12. Kanner AM, Bicchi MM. Antiseizure medications for adults with epilepsy. JAMA, 2022, 327(13): 1269-1281.
- 13. Kanner AM, Ashman E, Gloss D, et al. Practice guideline update summary: efficacy and tolerability of the new antiepileptic drugs I: treatment of new-onset epilepsy: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology, 2018, 91(2): 74-81.
- 14. Sign. SIGN 143 Diagnosis and management of epilepsy in adults. Edinburgh, 2015: 1-94.
- 15. Gonzalez-Viana E, Sen A, Bonnon A, et al. Epilepsies in children, young people, and adults: summary of updated NICE guidance. BMJ, 2022, 378: 1446.
- 16. Kanner AM, Ashman E, Gloss D, et al. Practice guideline update summary: efficacy and tolerability of the new antiepileptic drugs II: treatment-resistant epilepsy: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology, 2018, 91(2): 82-90.
- 17. Zhang Y, Gao B, Zheng F, et al. The phosphodiesterase 10A inhibitor PF-2545920 enhances hippocampal excitability and seizure activity involving the upregulation of GluA1 and NR2A in post-synaptic densities. Front Mol Neurosci, 2017, 10: 100.
- 18. Meldrum BS, Akbar MT, Chapman AG. Glutamate receptors and transporters in genetic and acquired models of epilepsy. Epilepsy Res, 1999, 36(2-3): 189-204.
- 19. Rogawski MA, L?scher W, Rho JM. Mechanisms of action of antiseizure drugs and the ketogenic diet. Cold Spring Harbor Perspectives in Medicine, 2016, 6(5): a022780.
- 20. Di Bonaventura C, Labate A, Maschio M, et al. AMPA receptors and perampanel behind selected epilepsies: current evidence and future perspectives. Expert Opinion on Pharmacotherapy, 2017, 18(16): 1751-1764.
- 21. 衛材(中國)藥業有限公司. 吡侖帕奈片說明書: [S]. 2020.
- 22. 中國抗癲癇協會. 臨床診療指南: 癲癇病分冊(2023修訂版). 北京: 人民出版社, 2023.
- 23. Yamamoto T, Gil-Nagel A, Wheless JW, et al. Perampanel monotherapy for the treatment of epilepsy: Clinical trial and real-world evidence. Epilepsy Behav, 2022, 136: 108885.
- 24. Yamamoto T, Lim SC, Ninomiya H, et al. Efficacy and safety of perampanel monotherapy in patients with focal‐onset seizures with newly diagnosed epilepsy or recurrence of epilepsy after a period of remission: The open‐label Study 342 (FREEDOM Study). Epilepsia Open, 2020, 5(2): 274-284.
- 25. Ma H, Zhu H, Chen F, et al. Efficacy and safety of perampanel monotherapy in Chinese patients with focal‐onset seizures: A single‐center, prospective, real‐world observational study. Epilepsia Open, 2023, 8(4): 1474-1483.
- 26. Bresnahan R, Hill RA, Wang J. Perampanel add-on for drug-resistant focal epilepsy. Cochrane Database of Systematic Reviews, 2023, 4(4): CD010961.
- 27. Rektor I, Krauss GL, Inoue Y, et al. Assessment of the long‐term efficacy and safety of adjunctive perampanel in tonic‐clonic seizures: Analysis of four open‐label extension studies. Epilepsia, 2020, 61(7): 1491-1502.
- 28. Gao L, Lu Q, Wang Z, et al. Efficacy and safety of perampanel as early add-on therapy in Chinese patients with focal-onset seizures: a multicenter, open-label, single-arm study. Frontiers in Neurology, 2023, 14: 1236046.
- 29. Glauser T, Laurenza A, Yang H, et al. Efficacy and tolerability of adjunct perampanel based on number of antiepileptic drugs at baseline and baseline predictors of efficacy: A phase III post-hoc analysis. Epilepsy Res, 2016, 119: 34-40.
- 30. French JA, Krauss GL, Wechsler RT, et al. Perampanel for tonic-clonic seizures in idiopathic generalized epilepsy A randomized trial. Neurology, 2015, 85(11): 950-957.
- 31. Weiping L, Dong Z, Zhen H, et al. Efficacy, safety, and tolerability of adjunctive perampanel in patients from China with focal seizures or generalized tonic‐clonic seizures: Post hoc analysis of phase III double‐blind and open‐label extension studies. CNS Neuroscience & Therapeutics, 2020, 27(3): 330-340.
- 32. 齊霜, 鄭舒暢, 余建東, 等. 抗癲癇藥物加重癲癇發作的現狀及機制研究進展. 中華神經醫學雜志, 2019, 18(7): 745-749.
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