國際獸醫(yī)癲癇工作組共識建議：歐洲犬癲癇的藥物治療

Sofie F.M. Bhatti1*, Luisa De Risio2 , Karen Mu?ana3 , Jacques Penderis4 , Veronika M. Stein5 , Andrea Tipold5 , Mette Berendt6 , Robyn G. Farquhar7 , Andrea Fischer8 , Sam Long9 , Wolfgang L?scher10, Paul J.J. Mandigers11, Kaspar Matiasek12, Akos Pakozdy13, Edward E. Patterson14, Simon Platt15, Michael Podell16, Heidrun Potschka17, Clare Rusbridge18,19 and Holger A. Volk20?

Background

背景

In Europe, the number of antiepileptic drugs (AEDs) licensed for dogs has grown considerably over the last years. Nevertheless, the same questions remain, which include, 1) when to start treatment, 2) which drug is best used initially, 3) which adjunctive AED can be advised if treatment with the initial drug is unsatisfactory, and 4) when treatment changes should be considered. In this consensus proposal, an overview is given on the aim of AED treatment, when to start long-term treatment in canine epilepsy and which veterinary AEDs are currently in use for dogs. The consensus proposal for drug treatment protocols, 1) is based on current published evidence-based literature [17], 2) considers the current legal framework of the cascade regulation for the prescription of veterinary drugs in Europe, and 3) reflects the authors’ experience. With this paper it is aimed to provide a consensus for the management of canine idiopathic epilepsy. Furthermore, for the management of structural epilepsy AEDs are inevitable in addition to treating the underlying cause, if possible.

在歐洲，獲得許可的犬用抗癲癇藥物(AEDs)的數(shù)量在過去數(shù)年里有了相當(dāng)大的增長。但是仍然存在類似的問題，包括：1）什么時(shí)候開始治療，2）最初使用哪種藥物最好，3）如果使用初始藥物治療效果不理想，可以建議使用哪種輔助抗癲癇藥物, ?4）什么時(shí)候應(yīng)考慮改變治療方法。在本共識建議中，概述了抗癲癇藥物治療的目的，什么時(shí)候開始犬癲癇的長期治療，以及目前有哪些獸醫(yī)用抗癲癇藥物用于犬類。關(guān)于藥物治療方案的本共識的建議，1）基于當(dāng)前已發(fā)表的循證文獻(xiàn)，2)考慮了歐洲獸藥處方級聯(lián)監(jiān)管的現(xiàn)行法律框架，3)反映了作者們的經(jīng)驗(yàn)。本文旨在為犬特發(fā)性癲癇的治療提供一個(gè)共識。此外，對于結(jié)構(gòu)性癲癇的管理，除了治療潛在的原因，如果可能的話，抗癲癇藥物是難免需要使用的。

At present, there is no doubt that the administration of AEDs is the mainstay of therapy. In fact, the term AED is rather inappropriate as the mode of action of most AEDs is to suppress epileptic seizures, not epileptogenesis or the pathophysiological mechanisms of epilepsy. Perhaps, in the future, the term anti-seizure drugs might be more applicable in veterinary neurology, a term that is increasingly used in human epilepsy. Additionally, it is known that epileptic seizure frequency appears to increase over time in a subpopulation of dogs with untreated idiopathic epilepsy, reflecting the need of AED treatment in these patients [63].

目前，毫無疑問，抗癲癇藥是主要的治療手段。事實(shí)上，抗癲癇藥物（antiepileptic drugs AEDs）這個(gè)詞并不恰當(dāng)，因?yàn)榇蠖鄶?shù)抗癲癇藥物的作用方式是抑制癲癇性抽搐發(fā)作，而不是致癇灶或癲癇的病理生理機(jī)制。也許，在未來，抗抽搐發(fā)作藥物（anti-seizure drugs）這個(gè)術(shù)語可能更適用于獸醫(yī)神經(jīng)學(xué)，這個(gè)術(shù)語越來越多地用于人類癲癇。此外，據(jù)了解，在未經(jīng)治療的特發(fā)性癲癇犬亞分類群體中，癲癇性抽搐發(fā)作頻率似乎隨著時(shí)間的推移而增加，這反映了這些病患需要抗癲癇藥治療[63]。

In our consensus proposal on classification and terminology we have defined idiopathic epilepsy as a disease in its own right, per se. A genetic origin of idiopathic epilepsy is supported by genetic testing (when available) and a genetic influence is supported by a high breed prevalence (>2 %), genealogical analysis and /or familial accumulation of epileptic individuals. However in the clinical setting idiopathic epilepsy remains most commonly a diagnosis of exclusion following diagnostic investigations for causes of reactive seizures and structural epilepsy.

在關(guān)于分類和術(shù)語的共識中，我們將特發(fā)性癲癇（idiopathic epilepsy）本身定義為一種疾病。特發(fā)性癲癇的遺傳起源可通過基因檢測得到支持(如果有的話)，而基因性影響可通過高品種患病率(> 2%)、族譜分析和/或癲癇性個(gè)體的家族積累而得到支持。然而，在臨床上，癲癇的原因除了反應(yīng)性抽搐發(fā)作和結(jié)構(gòu)性癲癇，最常見的仍然是特發(fā)性癲癇。