癫痫治疗：药物，手术，饮食等等

当癫痫发作是由癫痫引起的时，第一线治疗通常是药物。有20多种不同的抗癫痫药。有些人可能会更好地工作types of seizures而不是其他人，所有人都有副作用。（1,2)

The goal is to strike a balance between the upside of fewer seizures — and better quality of life — and the downside of bothersome medication side effects.

If medication proves ineffective at controlling seizures, other treatments may be required, such as epilepsy surgery, dietary changes,vagus nerve stimulation（VNS) therapy, or responsive neurostimulation. (3)

But before you stop taking an anti-seizure medication for any reason — including continued seizures, unacceptable side effects, or any other reason — talk to your doctor about stopping the drug or changing therapies. Don’t stop an anti-seizure drug on your own.

Normally, anti-seizure drugs are tapered — taken in progressively smaller doses — before they are stopped entirely. Abruptly stopping a medication raises the risk of withdrawal seizures.

Usually, a person with epilepsy will be started on one medication (“monotherapy”) at a low dose, and then the dosage will be gradually increased to find the proper dose for that person. This is done to try to minimize side effects. Almost half ofpeople with epilepsy用单一疗法癫痫发作。

Side effects from anti-seizure drugs (also called anti-epileptic drugs, or AEDs) are common, often leading to a reduced quality of life in people with epilepsy. Drowsiness, dizziness, double vision (diplopia), and impaired balance are common problems with all classes of anti-seizure medication.

其他副作用对个体药物更具体，但常见的副作用可以包括难以集中，恶心，震颤，rash，体重增加或损失和自杀思想。

Some people are eventually able to stop anti-seizure medication, but the ability to do so varies with age and type of seizure. One study showed that 75 percent of people who had been seizure-free for three years could discontinue medication without having more seizures. (1)

For about 1 out of 3 people with epilepsy, seizures are not controlled by medication. These people are referred to as having drug-resistant or “refractory” seizures.

Because using multiple anti-seizure drugs can lead to severe side effects, other treatments are often tried for refractory seizures.

Broad-Spectrum Anti-Seizure Drugs

These drugs are used to treat a broad range of seizure types, including both focal and generalized onset seizures:

• Banzel (rufinamide)
• Briviact (brivaracetam)
• Depakene, Depakote (valproic acid)
• Felbatol (felbamate)
• Fycompa（Perampanel）
• Keppra (levetiracetam)
• Lamictal (lamotrigine)
• Onfi (clobazam)
• Topamax (topiramate)
• Zonegran（Zonisamide）

Narrow-Spectrum Anti-Seizure Drugs, for Focal Seizures

These drugs are used for focal seizures, even if they evolve to generalized seizures:

• aptiom（eslicarbazepine）
• Dilantin（Phenytoin）
• Gabitril (tiagabine)
• Luminal (phenobarbital)
• 莱卡兰（Praetabalin）
• Neurontin，水平植物（加巴峰）
• Sabril (vigabatrin)
• Tegretol (carbamazepine)
• Trileptal (oxcarbazepine)
• Vimpat (lacosamide)

Narrow-Spectrum Anti-Seizure Drugs, for Generalized Absence Seizures

毒品Zarontin (ethosuximide)is used for absence seizures only.

大麻的抗癫痫药物

Epidiolex., a medication made from cannabidiol (CBD), a chemical present in the大麻苜蓿（大麻）植物，于2018年6月下旬批准食品和药物管理局（FDA）。

CBD不是大麻中的化学品，产生“高”;那是四氢甘油（THC）。

As of July 2018, Epidiolex has been approved for refractory seizures in patients older than 2 years caused by the childhood epilepsy conditionsDravet syndrome和Lennox-gastaut综合征。它是第一个被FDA批准的基于大麻的药物，以及批准的Dravet综合症的第一批药物。（4)

癫痫手术是唯一可以治愈耐火性癫痫发作的唯一选择，但有些人可能不是良好的手术候选人，或者他们可能不想要手术。

Any kind of surgery carries a level of risk, and brain surgeries can cause damage to surrounding tissue that can cause changes to a person’s cognitive (thinking) ability, or even to their personality.

癫痫的脑手术通常只考虑如果该人试过，并且没有看到至少两种抗癫痫药物的改善，以及癫痫发作的可识别原因。

There are a few main types of brain surgery for epilepsy: focal resection, corpus callosotomy, multiple subpial transection, and hemispherectomy. (5,6)

焦点切除Also known as lobectomy and lesionectomy, focal resection is the removal of the section of the brain where the seizures originate. This type of surgery is most likely to be successful at stopping seizures if doctors have identified a small and precise area of the brain where seizures originate, called the seizure focus.

Corpus CallosotomyThis type of surgery involves cutting the connections between the right and left halves (hemispheres) of the brain. Because generalized seizures are often focal (partial) seizures that then spread to both hemispheres of the brain, this surgery effectively keeps the seizure in the half of the brain where it started, so that only half the body is affected. Still, some people have a worsening of focal seizures after this procedure.

多个子页面转化在这种类型的手术中，将多个切口进行到脑组织中以破坏导致癫痫发作的电传动。如果不能去除大脑的抓住部分，则执行这种手术。

Hemispherectomy andHemispherotomy在一个解剖半spherectomy, the affected brain hemisphere is surgically removed. In a functional hemispherectomy, less brain tissue is removed, and the remaining brain is disconnected from the other hemisphere (as in corpus callosotomy). In a hemispherotomy, even less brain tissue is removed, and the affected brain is disconnected from the healthy brain.

If surgery is the appropriate course of treatment, experts recommend that it be performed sooner rather than later. Surgery can be an important and, some say, underutilized, treatment for people with drug-resistant focal epilepsy.

已经发现一些饮食变化有助于减少癫痫发作。其中大多数涉及减少carbohydrate（sugars and starches) in the diet. It’s not yet clear how these diets help to reduce seizures.

试图为癫痫试验的饮食的例子包括：

• The ketogenic diet
• The medium-chain triglyceride diet
• 修改了Atkins diet
• 低血糖指数饮食

Reducing carbohydrate intake causes the body to burn more fat for energy, and when the body burns fat, acids calledketonesare produced. Having a higher-than-normal amount of ketones in the bloodstream is known as “ketosis。” As long as there’s enough insulin available, the body can use ketones for energy.

Low-carbohydrate diets are also associated with lower glucose and insulin levels in the blood.

Researchers are unsure whether seizure improvement comes about because of changes caused by ketosis, by the presence of more fatty acids in the blood, or because there are fewer fluctuations in blood glucose levels.

All of these diets are best learned under the care of a physician and nutritionist. Strict diets like the ketogenic diet may begin with a brief admission to the hospital for monitoring and teaching, followed by ongoing assessment of laboratory levels. (7)

植入神经刺激装置代表治疗不受药物治疗的癫痫发作的另一种选择。

Vagus Nerve StimulatorVagus nerve stimulators were approved by the FDA in 1997. The device is surgically implanted under the skin of the chest, and electrodes connect the device to the left vagus nerve in the neck. The device sends regular pulses of electricity to the brain to control abnormal electrical activity in the brain. Although vagus nerve stimulation may reduce seizures by 20 to 40 percent, people who use them will usually also need to keep taking medication. (3)

响应性神经刺激在响应性神经刺激中，闭环系统分析大脑活动模式，然后如果检测到癫痫发作即将来临，则提供震动。第一个这样的系统，神经内容是2013年底的FDA批准的。电池供电装置在颅骨上植入，连接到器件的电线放置在大脑的表面或脑区域内部癫痫发作的地方。（8)

Deep Brain Stimulation (DBS)The Medtronic DBS System for Epilepsy was approved by the FDA in April 2018. The pulse generator portion of the device is implanted in the chest, and two wires lead to a seizure focus in the brain. The device controls seizures by delivering ongoing electrical pulses to that area. The device is used in adults with focal seizures who have more than six seizures a month and who have not seen good results with at least three drugs. Certain medical procedures, including magnetic resonance imaging (MRI）不能用DBS系统进行，或者可能发生永久性脑损伤。（9)