难治性癫痫的治疗进展
Advances in the Treatment of Refractory Epilepsy
摘要: 难治性癫痫(RE)是神经科面临的重大挑战，约30%的癫痫患者对现有抗癫痫药物(AEDs)治疗无效。目的：本文旨在综述近年来RE治疗策略的最新进展。方法：通过检索相关文献，从药物治疗、神经调控、外科手术、生酮饮食及新兴疗法等方面进行归纳分析。结果：RE治疗已进入多元化与个体化时代。新型AEDs (如大麻二酚、芬氟拉明)为特定综合征患者带来新希望；神经调控技术(VNS, RNS, DBS)为无法手术者提供了有效替代方案；术前评估技术的进步和微创外科技术(如LITT)显著提高了手术疗效与安全性；生酮饮食在儿童及成人RE中的应用得到进一步证实；基因治疗、免疫调节等新兴疗法展现出巨大潜力。结论：未来RE的治疗应综合多模态策略，依托精准医疗理念，结合生物标志物为患者制定个体化治疗方案，以期最大程度控制发作、提高生活质量。
Abstract: Refractory epilepsy (RE) poses a significant challenge in neurology, affecting approximately 30% of epilepsy patients who do not respond to existing anti-epileptic drugs (AEDs). Objective: This article aims to review the recent advances in treatment strategies for RE. Methods: A comprehensive literature search was conducted to summarize and analyze developments in pharmacological therapy, neuromodulation, surgical intervention, ketogenic diet, and emerging therapies. Results: The management of RE has entered an era of diversification and personalization. Novel AEDs (e.g., cannabidiol, fenfluramine) offer new hope for patients with specific syndromes; neuromodulation techniques (VNS, RNS, DBS) provide effective alternatives for those who are not suitable for surgery; advances in preoperative evaluation and minimally invasive techniques (e.g., LITT) have significantly improved surgical efficacy and safety; the application of the ketogenic diet in both pediatric and adult RE has been further validated; and emerging therapies such as gene therapy and immunomodulation show great potential. Conclusion: Future RE treatment should integrate multimodal strategies, leveraging the concept of precision medicine and utilizing biomarkers to develop individualized therapeutic plans, thereby maximizing seizure control and improving patients’ quality of life.
文章引用：梁福鑫, 高薇. 难治性癫痫的治疗进展[J]. 临床医学进展, 2025, 15(11): 294-301. https://doi.org/10.12677/acm.2025.15113097

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