儿童癫痫患者抗发作药物治疗与药物难治性 癫痫的研究进展
Research Progress on Antiseizure Medication Therapy and Drug-Resistant Epilepsy in Pediatric Patients with Epilepsy
DOI: 10.12677/acm.2026.162651, PDF,   
作者: 唐 丹, 李听松*：重庆医科大学附属儿童医院康复科，重庆
关键词: 儿童癫痫；抗发作药物；药物难治性癫痫；Pediatric Epilepsy； Antiseizure Medications； Drug-Resistant Epilepsy
摘要: 抗发作药物(antiseizure medications, ASMs)是儿童癫痫的一线治疗方法，但其疗效存在高度异质性。多数患儿经治疗后最终可实现长期无发作，然而，不同癫痫类型、病因及综合征间的缓解率差异显著，尤其以发育性癫痫性脑病(epileptic encephalopathies, DEEs)患者的预后最差。国际抗癫痫联盟(International League Against Epilepsy, ILAE)提出的药物难治性癫痫(drug-resistant epilepsy, DRE)定义是临床与研究的重要工具，但其在儿童患者中的直接适用性存疑，主要源于儿童癫痫病因、综合征等方面的特殊性。本综述旨在系统阐述儿童癫痫ASMs治疗结局的整体特征、异质性表现以及DRE的危险因素，并探讨现有评估工具在儿科领域的适用性争议与未来方向。
Abstract: In pediatric epilepsy, antiseizure medications (ASMs) are employed as the first-line therapeutic approach, yet their efficacy demonstrates substantial heterogeneity. While most children ultimately achieve long-term seizure freedom following treatment, remission rates vary significantly across different epilepsy types, etiologies, and syndromes, with the poorest prognosis observed particularly in patients with developmental epileptic encephalopathies (DEEs). The definition of drug-resistant epilepsy (DRE) proposed by the International League Against Epilepsy (ILAE) is an essential tool for both clinical practice and research; however, its direct applicability to pediatric patients remains questionable, primarily owing to the distinct characteristics of childhood epilepsy in terms of etiology and syndrome classification. This review aims to systematically elaborate on the overall features and heterogeneous outcomes of ASM treatment in pediatric epilepsy, identify risk factors associated with DRE, and discuss existing controversies regarding the applicability of current assessment tools in the pediatric field, along with future directions.
文章引用：唐丹, 李听松. 儿童癫痫患者抗发作药物治疗与药物难治性 癫痫的研究进展[J]. 临床医学进展, 2026, 16(2): 2462-2467. https://doi.org/10.12677/acm.2026.162651

参考文献

[1] Fiest, K.M., Sauro, K.M., Wiebe, S., Patten, S.B., Kwon, C., Dykeman, J., et al. (2017) Prevalence and Incidence of Epilepsy: A Systematic Review and Meta-Analysis of International Studies. Neurology, 88, 296-303. [Google Scholar] [CrossRef] [PubMed]
[2] Aaberg, K.M., Surén, P., Søraas, C.L., Bakken, I.J., Lossius, M.I., Stoltenberg, C., et al. (2017) Seizures, Syndromes, and Etiologies in Childhood Epilepsy: The International League against Epilepsy 1981, 1989, and 2017 Classifications Used in a Population-Based Cohort. Epilepsia, 58, 1880-1891. [Google Scholar] [CrossRef] [PubMed]
[3] Vikin, T., Lossius, M.I., Brandlistuen, R.E., Chin, R.F. and Aaberg, K.M. (2025) Incidence of Childhood and Youth Epilepsy: A Population-Based Prospective Cohort Study Utilizing Current International League against Epilepsy Classifications for Seizures, Syndromes, and Etiologies. Epilepsia, 66, 776-789. [Google Scholar] [CrossRef] [PubMed]
[4] Menon, R.N. and Helen Cross, J. (2025) Childhood Epilepsy. The Lancet, 406, 636-649. [Google Scholar] [CrossRef] [PubMed]
[5] Scheffer, I.E., Berkovic, S., Capovilla, G., Connolly, M.B., French, J., Guilhoto, L., et al. (2017) ILAE Classification of the Epilepsies: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia, 58, 512-521. [Google Scholar] [CrossRef] [PubMed]
[6] Fisher, R.S., Cross, J.H., French, J.A., Higurashi, N., Hirsch, E., Jansen, F.E., et al. (2017) Operational Classification of Seizure Types by the International League against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia, 58, 522-530. [Google Scholar] [CrossRef] [PubMed]
[7] Scheffer, I.E., Zuberi, S., Mefford, H.C., Guerrini, R. and McTague, A. (2024) Developmental and Epileptic Encephalopathies. Nature Reviews Disease Primers, 10, Article No. 61. [Google Scholar] [CrossRef] [PubMed]
[8] Kwan, P., Arzimanoglou, A., Berg, A.T., Brodie, M.J., Allen Hauser, W., Mathern, G., et al. (2010) Definition of Drug Resistant Epilepsy: Consensus Proposal by the Ad Hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia, 51, 1069-1077. [Google Scholar] [CrossRef] [PubMed]
[9] Sillanpää, M., Jalava, M., Kaleva, O. and Shinnar, S. (1998) Long-Term Prognosis of Seizures with Onset in Childhood. New England Journal of Medicine, 338, 1715-1722. [Google Scholar] [CrossRef] [PubMed]
[10] Vikin, T., Chin, R.F., Lossius, M.I., Hofoss, D., Brandlistuen, R.E. and Aaberg, K.M. (2025) Syndromic and Etiological Classification Predicts Seizure Freedom in Childhood and Youth Onset Epilepsy: A Population-Based Study from the Norwegian Mother, Father, and Child Cohort Study. Epilepsia, 1-15. [Google Scholar] [CrossRef] 
[11] Auvin, S., Galanopoulou, A.S., Moshé, S.L., Potschka, H., Rocha, L. and Walker, M.C. (2023) Revisiting the Concept of Drug-Resistant Epilepsy: A task1 Report of the ILAE/AES Joint Translational Task Force. Epilepsia, 64, 2891-2908. [Google Scholar] [CrossRef] [PubMed]
[12] Xie, K., Gallagher, R.S., Shinohara, R.T., Xie, S.X., Hill, C.E., Conrad, E.C., et al. (2023) Long-Term Epilepsy Outcome Dynamics Revealed by Natural Language Processing of Clinic Notes. Epilepsia, 64, 1900-1909. [Google Scholar] [CrossRef] [PubMed]
[13] Sillanpää, M. and Schmidt, D. (2006) Natural History of Treated Childhood-Onset Epilepsy: Prospective, Long-Term Population-Based Study. Brain, 129, 617-624. [Google Scholar] [CrossRef] [PubMed]
[14] Berg, A.T. and Rychlik, K. (2014) The Course of Childhood-Onset Epilepsy over the First Two Decades: A Prospective, Longitudinal Study. Epilepsia, 56, 40-48. [Google Scholar] [CrossRef] [PubMed]
[15] Berg, A.T., Shinnar, S., Levy, S.R., Testa, F.M., Smith-Rapaport, S., Beckerman, B., et al. (2001) Two-Year Remission and Subsequent Relapse in Children with Newly Diagnosed Epilepsy. Epilepsia, 42, 1553-1562. [Google Scholar] [CrossRef] [PubMed]
[16] Sultana, B., Panzini, M., Veilleux Carpentier, A., Comtois, J., Rioux, B., Gore, G., et al. (2021) Incidence and Prevalence of Drug-Resistant Epilepsy: A Systematic Review and Meta-Analysis. Neurology, 96, 805-817. [Google Scholar] [CrossRef] [PubMed]
[17] Zheng, R., Lei, Z., Yang, R., Huang, G. and Zhang, G. (2020) Identification and Management of Paroxysmal Sympathetic Hyperactivity after Traumatic Brain Injury. Frontiers in Neurology, 11, Article 81. [Google Scholar] [CrossRef] [PubMed]
[18] Geerts, A., Brouwer, O., Stroink, H., van Donselaar, C., Peters, B., Peeters, E., et al. (2012) Onset of Intractability and Its Course over Time: The Dutch Study of Epilepsy in Childhood. Epilepsia, 53, 741-751. [Google Scholar] [CrossRef] [PubMed]
[19] Karaoğlu, P., Yiş, U., Polat, A.İ., Ayanoğlu, M. and Hiz, S. (2021) Clinical Predictors of Drug-Resistant Epilepsy in Children. Turkish Journal of Medical Sciences, 51, 1249-1252. [Google Scholar] [CrossRef] [PubMed]
[20] Nasiri, J., Ghazzavi, M., Sedghi, M., et al. (2023) Causes and Risk Factors of Drug-Resistant Epilepsy in Children. Iranian Journal of Child Neurology, 17, 79-85.
[21] Aaberg, K.M., Bakken, I.J., Lossius, M.I., Lund Søraas, C., Tallur, K.K., Stoltenberg, C., et al. (2018) Short-Term Seizure Outcomes in Childhood Epilepsy. Pediatrics, 141, e20174016. [Google Scholar] [CrossRef] [PubMed]
[22] Hale, A.T., Chari, A., Scott, R.C., Helen Cross, J., Rozzelle, C.J., Blount, J.P., et al. (2022) Expedited Epilepsy Surgery Prior to Drug Resistance in Children: A Frontier Worth Crossing? Brain, 145, 3755-3762. [Google Scholar] [CrossRef] [PubMed]
[23] Moon, J.U. and Cho, K. (2021) Current Pharmacologic Strategies for Treatment of Intractable Epilepsy in Children. International Neurourology Journal, 25, S8-18. [Google Scholar] [CrossRef] [PubMed]
[24] Fukuda, M., Matsuo, T., Fujimoto, S., Kashii, H., Hoshino, A., Ishiyama, A., et al. (2024) Vagus Nerve Stimulation Therapy for Drug-Resistant Epilepsy in Children—A Literature Review. Journal of Clinical Medicine, 13, Article 780. [Google Scholar] [CrossRef] [PubMed]
[25] Xie, H., Ma, J., Ji, T., Liu, Q., Cai, L. and Wu, Y. (2022) Vagus Nerve Stimulation in Children with Drug-Resistant Epilepsy of Monogenic Etiology. Frontiers in Neurology, 13, Article 951850. [Google Scholar] [CrossRef] [PubMed]
[26] Saenchai, W., Manopunya, S., Kosarat, S., Khuwuthyakorn, V., Tantiprabha, W., Katanyuwong, K., et al. (2025) Drug-resistant Epilepsy in Children Post-Neonatal Seizures: Clinical Profiles and Predictors. Brain and Development, 47, Article ID: 104373. [Google Scholar] [CrossRef] [PubMed]
[27] Berg, A.T., Shinnar, S., Levy, S.R., Testa, F.M., Smith-Rapaport, S. and Beckerman, B. (2001) Early Development of Intractable Epilepsy in Children: A Prospective Study. Neurology, 56, 1445-1452. [Google Scholar] [CrossRef] [PubMed]
[28] Gururaj, A., Sztriha, L., Hertecant, J. and Eapen, V. (2006) Clinical Predictors of Intractable Childhood Epilepsy. Journal of Psychosomatic Research, 61, 343-347. [Google Scholar] [CrossRef] [PubMed]
[29] Kwan, P. and Brodie, M.J. (2000) Early Identification of Refractory Epilepsy. New England Journal of Medicine, 342, 314-319. [Google Scholar] [CrossRef] [PubMed]
[30] Perucca, E., Perucca, P., White, H.S. and Wirrell, E.C. (2023) Drug Resistance in Epilepsy. The Lancet Neurology, 22, 723-734. [Google Scholar] [CrossRef] [PubMed]
[31] Cavalcante, T.B., Ribeiro, M.R.C., Sousa, P.D.S., Costa, E.D.P.F., de Britto e Alves, M.T.S.S., Simões, V.M.F., et al. (2022) Characteristics Associated with Drug Resistant Epilepsy in Children up to 36 Months Old with Congenital Zika Syndrome. Seizure: European Journal of Epilepsy, 103, 92-98. [Google Scholar] [CrossRef] [PubMed]
[32] Holmes, G.L. and Engel, J. (2001) Predicting Medical Intractability of Epilepsy in Children: How Certain Can We Be? Neurology, 56, 1430-1431. [Google Scholar] [CrossRef] [PubMed]
[33] Sharma, P., Hussain, A. and Greenwood, R. (2019) Precision in Pediatric Epilepsy. F1000Research, 8, Article 163. [Google Scholar] [CrossRef] [PubMed]
[34] Kim, J., Shaker, B., Ko, A., Yoo, S., Na, D. and Kang, H. (2025) Precision Medicine Approach for in Vitro Modeling and Computational Screening of Anti-Epileptic Drugs in Pediatric Epilepsy Patients with SCN2A (R1629L) Mutation. Computers in Biology and Medicine, 191, Article ID: 110100. [Google Scholar] [CrossRef] [PubMed]
[35] Auvin, S. and Specchio, N. (2024) Pharmacotherapeutic Strategies for Drug-Resistant Epilepsy in Children. Epilepsy & Behavior, 161, Article ID: 110139. [Google Scholar] [CrossRef] [PubMed]
[36] Wirrell, E.C., Nabbout, R., Scheffer, I.E., Alsaadi, T., Bogacz, A., French, J.A., et al. (2022) Methodology for Classification and Definition of Epilepsy Syndromes with List of Syndromes: Report of the ILAE Task Force on Nosology and Definitions. Epilepsia, 63, 1333-1348. [Google Scholar] [CrossRef] [PubMed]
[37] Chen, Z., Brodie, M.J., Liew, D. and Kwan, P. (2018) Treatment Outcomes in Patients with Newly Diagnosed Epilepsy Treated with Established and New Antiepileptic Drugs: A 30-Year Longitudinal Cohort Study. JAMA Neurology, 75, Article 279. [Google Scholar] [CrossRef] [PubMed]

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