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?

Choice of AED therapy

抗癲癇藥物治療的選擇

There are no evidence-based guidelines regarding the choice of AEDs in dogs. When choosing an AED for the management of epilepsy in dogs several factors need to be taken into account (AED-specific factors (e.g. regulatory aspects, safety, tolerability, adverse effects, drug interactions, frequency of administration), dog-related factors (e.g. seizure type, frequency and aetiology, underlying pathologies such as kidney/hepatic/gastrointestinal problems) and owner-related factors (e.g. lifestyle, financial circumstances)) [23]. In the end, however, AED choice is often determined on a case-by-case basis.

目前還沒有循證的指南來指導(dǎo)犬如何選擇抗癲癇藥物。

在選擇抗癲癇藥物治療犬的癲癇時，需要考慮多個因素(抗癲癇藥物特異性因素(如監(jiān)管方面、安全性、耐受性、不良反應(yīng)、藥物相互作用、給藥頻率)、與犬相關(guān)的因素(如抽搐發(fā)作類型、頻率和病因、潛在病理如腎/肝/胃腸道問題)以及與寵主相關(guān)的因素(如生活方式、經(jīng)濟狀況))[23]。

然而最終，抗癲癇藥物的選擇通常視情況而定。

Until recently, primary treatment options for dogs with epilepsy have focused mainly on phenobarbital (PB) and potassium bromide (KBr) due to their long standing history, widespread availability, and low cost. While both AEDs are still widely used in veterinary practice, several newer AEDs approved for use in people are also being used for the management of canine idiopathic epilepsy mainly as add-on treatment. Moreover, since early 2013, imepitoin has been introduced in most European countries for the management of recurrent single generalized epileptic seizures in dogs with idiopathic epilepsy.

直到最近，癲癇犬的主要治療仍然是使用苯巴比妥（phenobarbital PB）和溴化鉀（potassium bromide KBr），它們歷史悠久、可用性廣而且成本低。

這兩種抗癲癇藥物在獸醫(yī)臨床廣泛使用的同時，也有多種獲準用于人類的新型抗癲癇藥也被用于管理犬的特發(fā)性癲癇，主要是作為輔助治療。

此外，自2013年初以來，大多數(shù)歐洲國家已引入伊匹妥因（imepitoin），用于治療特發(fā)性癲癇犬的復(fù)發(fā)性單次全身性癲癇性抽搐發(fā)作。

Several AEDs of the older generation approved for humans have been shown to be unsuitable for use in dogs as most have an elimination half-life that is too short to allow convenient dosing by owners, these include phenytoin, carbamazepine, valproic acid, and ethosuximide [119]. Some are even toxic in dogs such as lamotrigine (the metabolite is cardiotoxic) [26, 136] and vigabatrin (associated with neurotoxicity and haemolyticanemia) [113, 131, 138].

一些被批準用于人類的老一代抗癲癇藥物已被證明不適合用于犬，因為大多數(shù)抗癲癇藥物對于犬來說的消除半衰期太短，不能方便地讓寵主給藥，這些抗癲癇藥物包括苯妥英（phenytoin）、卡馬西平（carbamazepine）、丙戊酸（valproic acid）和乙琥胺（ethosuximide）[119]。

有些甚至對犬有毒，如拉莫三嗪（lamotrigine）（其代謝物具有心臟毒性）[26,136]和氨己烯酸（vigabatrin）（與神經(jīng)毒性和溶血性貧血有關(guān))[113,131,138]。

Since the 1990s, new AEDs with improved tolerability, fewer side effects and reduced drug interaction potential have been approved for the management of epilepsy in humans. Many of these novel drugs appear to be relatively safe in dogs, these include levetiracetam, zonisamide, felbamate, topiramate, gabapentin, and pregabalin. Pharmacokinetic studies on lacosamide [68] and rufinamide [137] support the potential use of these drugs in dogs, but they have not been evaluated in the clinical setting. Although these newer drugs have gained considerable popularity in the management of canine epilepsy, scientific data on their safety and efficacy are very limited and cost is often prohibitive.

自20世紀90年代以來，耐受性更好、副作用更少、藥物相互作用可能性更低的新型抗癲癇藥已被批準用于治療人類癲癇。

許多新型藥物在犬身上似乎相對安全，包括左乙拉西坦（levetiracetam）、唑尼沙胺（zonisamide）、非爾氨脂（felbamate）、托吡酯（topiramate）、加巴噴?。╣abapentin）和普瑞巴林（pregabalin）。

拉科酰胺（lacosamide）[68]和盧非酰胺（rufinamide）[137]的藥代動力學(xué)研究支持這些藥物在犬上的潛在應(yīng)用，但尚未在臨床環(huán)境中進行評估。

盡管這些新藥在治療犬癲癇方面已經(jīng)獲得了相當大的普及，但關(guān)于其安全性和有效性的科學(xué)數(shù)據(jù)非常有限，而且成本往往令人望而卻步。