从AES 2020年会热点看癫痫最新治疗进展。
一年一度的美国癫痫学会（AES）年会再度召开，本次年会的宗旨是为癫痫诊疗领域的最佳诊疗经验和突破性研究结果提供最广泛的教育学习及科学交流的机会，并通过创新的虚拟网络形式让该领域中的同仁们建立紧密的联系。
AES 2020年会热点回顾
今年AES年会首次以线上方式举办，12月4-8日期间多位大咖学者分别围绕新皮质癫痫的争议、癫痫性脑病的病因、治疗和结局、新发和耐药性癫痫的诊断和治疗方面的进展等众多方面展开了精彩分享与讨论[1]。
小编带大家一起来看一下今年AES年会的热点有哪些？
与既往年会相同，临床诊断、药物治疗、手术治疗、神经影像学等仍然是今年AES年会聚焦的热点话题[1]。
图1 AES年会热点话题
抗癫痫药物治疗：
“老树开新花” vs “新药新突破”
药物治疗作为癫痫治疗最重要和最基本的治疗，也是癫痫的首选治疗。今年AES年会也分享了抗癫痫药物的最新研究结果，包括一些上市已久的药物和新上市的药物。
传统抗癫痫药物苯妥英、拉莫三嗪、奥卡西平和氯巴占上市已久，本次AES年会分享的最新研究进展表明传统药物在癫痫治疗仍中占据“一席之地”[2-6]。
图2 传统药物最新研究进展
近年来抗癫痫药物的研发从未停下脚步，AES年会也呈现了新型抗癫痫药物如cenobamate和芬氟拉明的最新研究进展[7-8]，预示未来抗癫痫治疗有望出现新的获益。
图3 新药cenobamate和芬氟拉明最新研究进展
除此之外，年会也分享了第三代抗癫痫药物如醋酸艾司利卡西平、布瓦西坦、拉考沙胺和吡仑帕奈等的最新研究进展[9-12]。其中特别引人注目的是吡仑帕奈，由于具有全新作用靶点，新结果众多，成为会议的耀眼明星。
图4 第三代抗癫痫药物最新研究进展
吡仑帕奈：AES年会的“耀眼明星”
作为一种全新机制的抗癫痫药物，吡仑帕奈与突触后膜上的α-氨基-3-羟基-5-甲基-4-异恶唑丙酸受体（AMPA受体）非竞争性结合，从而抑制谷氨酸诱导的过度神经传递，发挥抗癫痫作用。今年AES年会上展示吡仑帕奈相关摘要高达50多篇，主要有311、FAME、342、504、506、238、315、332研究、多个研究的中期报告和事后汇总分析、真实世界研究的数据及汇总分析等[13]。
这里，小编主要总结一下吡仑帕奈添加治疗用于4~12岁儿童癫痫患者[14-19]、吡仑帕奈添加治疗用于原发性全面性强直阵挛发作患者[16-20]、吡仑帕奈单药治疗用于癫痫患者[21-23]的最新结果。
图5 吡仑帕奈的多个研究成果
众所周知，儿童时期作为癫痫的高发时期之一，其治疗一直也备受关注。吡仑帕奈添加治疗用于4~12岁儿童局灶性癫痫患者具有良好的疗效、安全性和耐受性，未来有望成为儿童癫痫患者的理想之选。除此之外，今年AES年会中吡仑帕奈添加治疗用于原发性全面性强直阵挛发作患者的疗效喜人，值得进一步探讨其在该人群中的应用价值。
目前癫痫单药治疗的效果仍不理想，新药研发从未止步。吡仑帕奈作为全新机制的抗癫痫药物，其较高的癫痫无发作率和保留率无疑为广大癫痫患者带来了更多获益。
据小编了解，本次AES年会中，日本卫材公司作为白金赞助商出席，表明其对癫痫领域十分重视且投入巨大。卫材新药卫克泰（吡仑帕奈片）在国内正式开售一年，虽然受新冠肺炎疫情影响，国内学术会议相对较少，但我们在今年各种学术交流场合也能听到临床医生比较良好的治疗体验和反馈，希望随着新药的上市、能为更多癫痫患者带来治疗希望！
参考文献：
1.https://meeting.aesnet.org/
2.JoelOster, Matthew Tucker, Kimberly Parkerson, et al. REFRACTORY STATUS EPILEPTICUSTERMINATED BY PHENYTOIN AT TUFTS MEDICAL CENTER IN BOSTON MA. 2020AES，Abstract782
3.AshwinKaranam, Page Pennell, Kimford Meador, et al. ANTISEIZURE MEDICATION CONCENTRATIONTRENDS IN PREGNANCY AND POSTPARTUM: RESULTS FROM THE MONEAD STUDY. 2020AES，Abstract 991
4.CharulAvachat, Ashwin Karanam, Page Pennell, et al. CHARACTERIZATION OF LAMOTRIGINEDOSING SCENARIOS WHEN CO-PRESCRIBED WITH COMBINED ORAL CONTRACEPTIVES. 2020AES，Abstract997
5.SidraSaleem, Ajaz Sheikh , Anum Riaz, et al. LEVETIRACETAM, LAMOTRIGINE, LACOSAMIDEAND TOPIRAMATE MONOTHERAPY; DATABASE ANALYSIS FROM AN EPILEPSY CENTER. 2020AES，Abstract357
6.FawadKhan, Uma Menon, Corinne Abraham, et al . TOLERABILITY OF HIGHER DOSE OFCLOBAZAM (60-160 MG/DAY) AS AN ADJUVANT THERAPY IN ADULT EPILEPSY PATIENTS.2020AES，Abstract 990
7.PavelKlein, David G. Vossler, Gregory L. Krauss, et al. EFFICACY OF CENOBAMATE BYCONCOMITANT ANTISEIZURE MEDICATIONS IN PATIENTS WITH UNCONTROLLED FOCALSEIZURES: POST-HOC ANALYSIS OF A PHASE 3, MULTICENTER, OPEN-LABEL STUDY.2020AES，Abstract 335
8.IngridScheffer, Orrin Devinsky, Scott Perry, et al. EFFICACY AND TOLERABILITY OFADJUNCTIVE FINTEPLA (FENFLURAMINE HYDROCHLORIDE) IN AN OPEN-LABEL EXTENSIONSTUDY OF DRAVET SYNDROME PATIENTS TREATED FOR UP TO 3 YEARS. 2020AES，Abstract978
9.RuiLoureiro, João Chaves, Coronado, et al. SAFETY AND TOLERABILITY OFESLICARBAZEPINE ACETATE AS ADJUNCTIVE TREATMENT IN ADULT PATIENTS WITH FOCAL-ONSET SEIZURES ACCORDING TO ONE CONCOMITANT ANTIEPILEPTIC DRUG: DATA FROM FOURDOUBLE-BLIND PIVOTAL PHASE III STUDIES. . 2020AES，Abstract 985
10.SamiAboumatar, David Cantu, David Blum, et al. EFFICACY OF ADJUNCTIVEESLICARBAZEPINE ACETATE IN PATIENTS WITH FOCAL SEIZURES, ACCORDING TO BASELINESEIZURE FREQUENCY: A POST-HOC ANALYSIS OF DATA FROM A PHASE IV CLINICAL TRIAL.2020AES，Abstract 774
11.BernhardJ Steinhoff, Colin P Doherty, Marian Majoie, et al. EFFECTIVENESS AND QUALITYOF LIFE DURING 12-MONTH ADJUNCTIVE BRIVARACETAM TREATMENT IN A REAL-LIFESETTING: INTERIM DATA FROM A PROSPECTIVE OBSERVATIONAL STUDY IN EUROPE. 2020AES，Abstract126
12.AlessandraMilesi-Halle, Pensirikul Alyssa, Manuel Melo Bicchi, et al. SAFETY ANDTOLERABILITY OF LACOSAMIDE FOR NEONATAL SEIZURES IN PRETERM INFANTS. 2020AES，Abstract998
13.https://www.aesnet.org/annual_meeting/abstract_search#/sortDate_na_dt/DESC/0/Perampanel-/?Year=2020
14.Steven Phillips, Andras Fogarasi, Robert Flamini, etal. Long-Term Effect of Adjunctive Perampanel on Clinical Global Impression inPediatric Patients (Aged 4 to <12 Years) with Partial-Onset or PrimaryGeneralized Tonic-Clonic Seizures in Study 311. 2020AES，Abstract341
15.Toshihide Watanabe, Hiroo Omatsu, Ryutaro Kira, et al.Effect of Concomitant Anti-Seizure Medications (ASMs) During Long-Term (52weeks) Adjunctive Perampanel Treatment in Japanese Pediatric Patients (Aged 4–<12Years): Post Hoc Analysis of Study 311. 2020AES，Abstract 565
16.RobertFlamini, Anna Patten, Manoj Malhotra, et al. Long-term Seizure Freedom withAdjunctive Perampanel in Pediatric Patients (Aged 4–<12 years) withPartial-Onset Seizures or Primary Generalized Tonic-Clonic Seizures: Post HocAnalysis of Study 311. 2020AES，Abstract 564
17.Hideaki Shiraishi, Hiroo Omatsu, Toshihide Watanabe, etal. Long-Term (52 weeks) Safety of Adjunctive Perampanel Based on Weight andDose in Japanese Pediatric Patients (Aged 4 to <12 Years) with Partial-OnsetSeizures in Study 311. 2020AES，Abstract346
18.Rohit Shankar, Jay Salpekar, Anna Patten, et al. Long-termEvaluation of Adjunctive Perampanel on Mental Health in Pediatric Patients withPartial-Onset Seizures (POS) or Primary Generalized Tonic-Clonic Seizures(PGTCS) in Study 311. 2020AES，Abstract 762.
19.HirooOmatsu, Toshihide Watanabe, Ryutaro Kira, et al. Long-Term (52 weeks) Effectsof Adjunctive Perampanel on Cognition, Growth, and Development in Japanese PediatricPatients (Aged 4 to <12 Years) with Partial-Onset Seizures in Study 311.2020AES，Abstract 347
20.AlejandroSalah, Anna Patten, Manoj Malhotra. Adjunctive Perampanel for PrimaryGeneralized Tonic-Clonic Seizures: Time to Seizure Onset in Phase III Study332. 2020AES，Abstract 132
21.YuichiKubota, Ji Hyun Kim, Sung Chul Lim, et al. Sustained Seizure Freedom withPerampanel 4 mg/day Monotherapy in Patients with Newly Diagnosed/CurrentlyUntreated Recurrent Partial-Onset Seizures: Post Hoc Analysis of Study 342(FREEDOM). 2020AES，Abstract 556
22.AntonioGil-Nagel, James Wheless, Ji Hyun Kim, et al. Perampanel Monotherapy for theTreatment of Epilepsy: Evidence From a Clinical Trial and Real-World Use.2020AES，Abstract 136
23.Y.Chinvarun. Real-world data of Perampanel as monotherapy for new onset focalseizures : A Thailand experience. 2020AES，Abstract 349
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