氯巴占治疗难治性癫痫专家共识(2022)

Expert Consensus on Clobazam in the Treatment of Refractory Epilepsy (2022)

  • 摘要: 多数癫痫患者经规范化抗癫痫治疗后,症状可得到良好控制或缓解,但30%~40%患者经长期药物干预后,仍反复出现癫痫发作,进展为难治性癫痫。Lennox-Gastaut综合征、Dravet综合征和肌阵挛-失张力癫痫均为儿童期起病的难治性癫痫,严重威胁患者的身心健康。2011年美国食品药品监督管理局批准氯巴占用于年龄≥ 2岁Lennox-Gastaut综合征患者癫痫发作的辅助治疗,且该药品在Dravet综合征和肌阵挛-失张力癫痫的治疗中也有一定应用。目前,氯巴占的药理作用机制尚未完全明确,可能通过与γ-氨基丁酸A受体上的苯二氮艹卓类位点相结合发挥药理作用。在体内,氯巴占和N-去甲氯巴占主要经CYP3A4、CYP2C19代谢,临床应用时需警惕与其他药物的相互作用。对于CYP2C19慢代谢患者,还应关注N-去甲氯巴占的血药浓度,并监测药物相关不良反应。为促进氯巴占在我国临床应用的进一步规范化,保障临床用药的有效性和安全性,北京协和医院罕见病多学科协作组联合中国罕见病联盟,组织相关领域专家,经多次讨论、修改,最终制定了本共识,以供临床参考。

     

    Abstract: After regular anti-epileptic drug treatment, the symptoms of most patients with epilepsy can be well controlled or relieved, but 30%-40% of patients with epilepsy, after long-term drug treatment, still suffer from repeated seizures and develop refractory epilepsy. Lennox-Gastaut syndrome, Dravet syndrome and epilepsy with myoclonic-atonic seizures are all refractory epilepsy that originate in childhood and seriously threaten the physical and mental health of patients. In 2011, clobazam was approved by the US Food and Drug Administration for the adjunctive treatment of epileptic seizures in patients with Lennox-Gastaut syndrome aged≥2 years. The drug has also been used in the treatment of Dravet syndrome and epilepsy with myoclonic-atonic seizures. Currently, the mechanism of action of clobazam is still unclear, but it may exert pharmacological effects by binding to the benzodiazepine site on the γ-aminobutyric acid A receptor. In vivo, clobazam and N-desmethylclobazam are mainly metabolized by CYP3A4 and CYP2C19, and the interaction with other drugs should require vigilance in clinical application. Meanwhile, attention should also be paid to the blood concentration of N-desmethylclobazam and monitoring of drug-related adverse reactions in CYP2C19 poor metabolizers. To promote further standardization of clinical application of clobazam in our country, and to ensure the effectiveness and safety of clobazam, the Multi-disciplinary Team for Rare Diseases, Peking Union Medical College Hospital and the National Rare Diseases Committee organized experts and scholars in related fields, and after many discussions and revisions, finally formed this consensus for clinical reference.

     

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