癫痫用药问题

对于大发作、小发作、精神运动性发作的选药顺序分别是什么？这是论坛上的填空题，本人不会答，有请老师帮忙！

原题呢，晒出来看看

Partial seizures with or without secondary generalisation
Carbamazepine, lamotrigine, oxcarbazepine, and sodium valproateare the drugs of choice for partial (focal) seizures; second-line drugs include clobazam, gabapentin, levetiracetam, pregabalin, tiagabine, topiramate, and zonisamide.

Generalised seizures
Tonic-clonic seizures (grand mal)
The drugs of choice for tonic-clonic seizures are carbamazepine, lamotrigine, and sodium valproate. Clobazam, levetiracetam, oxcarbazepine, and topiramate are second-line drugs.

Absence seizures (petit mal)
Ethosuximide and sodium valproate are the drugs of choice in typical absence seizures; alternatives include clonazepam and lamotrigine. Sodium valproate is also highly effective in treating the generalised tonic-clonic seizures which can co-exist with absence seizures in idiopathic primary generalised epilepsy.

Myoclonic seizures
Myoclonic seizures (myoclonic jerks) occur in a variety of syndromes, and response to treatment varies considerably. Sodium valproate is the drug of choice; clonazepam and levetiracetam can also be used. Alternatives include lamotrigine and topiramate, but lamotrigine may occasionally exacerbate myoclonic seizures. For reference to the adjunctive use of piracetam, see section 4.9.3.

Sodium valproate and levetiracetam are effective in treating the generalised tonic-clonic seizures that co-exist with myoclonic seizures in idiopathic generalised epilepsy.

Atypical absence, atonic, and tonic seizures
Atypical absence, atonic, and tonic seizures are usually seen in childhood, in specific epilepsy syndromes, or associated with cerebral damage or mental retardation. They may respond poorly to the traditional drugs. Sodium valproate, lamotrigine, and clonazepam can be tried. Second-line drugs that are occasionally helpful include clobazam, ethosuximide, levetiracetam, and topiramate.

BNF 57....

不过一般都是先用sodium valproate

请帮我翻译一下好吗？本人看不懂。

对于大发作、小发作、精神运动性发作的选药顺序分别是什么？这是论坛上的填空题，本人不会答，有请老师帮忙！
祝药师 发表于 2009-6-13  19:08

药物的选择主要取决于痫性发作的类型，应首选疗效高、毒性小、价格低廉的药物。　　
小发作首选乙琥胺，其次是丙戊酸钠；
肌阵挛发作首选丙戊酸钠，必要时可加服乙琥胺或氯硝安定；
大发作可选用卡马西平、苯妥英钠、丙戊酸钠、苯巴比妥；　
单纯或复杂部分性发作继发大发作首选苯妥英钠、卡马西平、苯巴比妥；　
复杂部分性发作首选卡马西平。
精神运动性发作 又称"复杂部分性发作"。

看完你的题目后， 脑中马上弹出三种药，大发作，首选苯妥英钠；小发作，首选乙琥胺；复杂部分性发作，首选卡马西平！
不过知道回答太简单，没深入，要向反老师学习！回答都很有水准！

学习学习了，谢谢。

部分性发作和继发全身性发作 卡马西平，苯妥英钠，苯巴比妥，丙戊酸
全身强直-阵挛性发作 丙戊酸，卡马西平，苯妥英钠
强直性发作 卡马西平，苯妥英钠，苯巴比妥，丙戊酸
阵挛性发作 丙戊酸，卡马西平
典型失神、肌阵挛发作 丙戊酸、乙琥胺、氯硝西泮
非典型失神发作 丙戊酸，氯硝西泮，乙琥胺

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