BACKGROUND & AIMS: :The aim of this study was to quantitatively review randomized controlled trials (RCTs) and open-label trials analyzing the efficacy of antidepressants, mood stabilizers, and antipsychotics for the treatment of the core symptoms of borderline personality disorder (BPD). Using a similar meta-analytic approach, the efficacy of placebo on the same core symptoms of BPD was evaluated. The risk of discontinuation of each of the medication classes reported in the studies was also analyzed to establish the major causes of discontinuation. MEDLINE (1966 to June 2010) and EMBASE (1980 to June 2010) databases were systematically searched to identify relevant RCTs and open studies. The primary outcome was improvement in the specific core symptoms of the disorder: affective dysregulation, impulsive-behavioral dyscontrol, and cognitive-perceptual symptoms. Evidence from RCTs and open studies suggests that drug treatment, especially with mood stabilizers and antipsychotics, may be effective for treating affective dysregulation and impulsive-behavioral dyscontrol. Antipsychotics were also effective in reducing cognitive-perceptual symptoms. Antidepressants failed to show efficacy in treating BPD symptom dimensions other than affective dysregulation. Our analyses of the placebo arm of RCTs showed a significant improvement of symptomatology in these patients also. There were no significant differences in overall dropout rates between patients on medications and those on placebo. In conclusion, the efficacy of pharmacological treatment on the symptom dimensions of BPD has been shown by various independent meta-analyses, with a positive effect of drug treatment on the core symptoms of BPD and some documentable differences in terms of efficacy between different drug classes in each of the symptom domains.

背景与目标： : 本研究的目的是定量回顾随机对照试验 (RCTs) 和开放标签试验，分析抗抑郁药，情绪稳定剂和抗精神病药治疗边缘性人格障碍 (BPD) 核心症状的疗效。使用类似的荟萃分析方法，评估了安慰剂对BPD相同核心症状的疗效。还分析了研究中报告的每种药物类别的停药风险，以确定停药的主要原因。系统地搜索MEDLINE (1966至2010年6月) 和EMBASE (1980至2010年6月) 数据库，以识别相关的rct和开放研究。主要结果是改善该疾病的特定核心症状: 情感障碍，冲动行为控制障碍和认知知觉症状。RCTs和开放研究的证据表明，药物治疗，尤其是使用情绪稳定剂和抗精神病药，可能对治疗情感失调和冲动行为控制障碍有效。抗精神病药在减轻认知知觉症状方面也有效。抗抑郁药在治疗BPD症状方面没有表现出除情感失调以外的功效。我们对rct安慰剂组的分析表明，这些患者的症状学也有显着改善。服用药物的患者和服用安慰剂的患者的总体辍学率没有显着差异。总之，通过各种独立的荟萃分析显示了药物治疗对BPD症状维度的疗效，药物治疗对BPD核心症状的积极作用以及在每个症状领域中不同药物类别之间的疗效方面的一些可证明的差异。

BACKGROUND & AIMS: :Emerging evidence from animal models of neuropathic pain suggests that many pathophysiologic and biochemical changes occur in the peripheral and central nervous system. Similarities between the pathophysiologic phenomena observed in some epilepsy models and in neuropathic pain models justify the use of anticonvulsants in the symptomatic management of neuropathic pain. Positive results from laboratory and clinical trials further support such use. Carbamazepine was the first of this class of drugs to be studied in clinical trials and has been longest in use for treatment of neuropathic pain. Clinical trial data support its use in treating trigeminal neuralgia, but data for treatment of painful diabetic neuropathy are less convincing. Use of newer anticonvulsants has marked a new era in the treatment of neuropathic pain. Gabapentin has demonstrated efficacy, specifically in painful diabetic neuropathy and postherpetic neuralgia. Lamotrigine has been reported to be effective in relieving pain from trigeminal neuralgia refractory to other treatments, HIV neuropathy, and central post-stroke pain. Results from clinical trials of phenytoin are equivocal. Zonisamide's mechanisms of action suggest that it would be effective in controlling neuropathic pain symptoms. Other anticonvulsants, including lorazepam, valproate, topiramate, and tiagabine, have also been under investigation. Anecdotal experience provides support for studies with oxcarbazepine and levetiracetam for treating neuropathic pain. Evidence supporting the efficacy of anticonvulsants in treatment of such pain is evolving. Additional clinical trials should provide information that will better define their role in neuropathic pain.

背景与目标： : 来自神经性疼痛动物模型的新证据表明，周围和中枢神经系统发生了许多病理生理和生化变化。在某些癫痫模型和神经性疼痛模型中观察到的病理生理现象之间的相似性证明在神经性疼痛的症状治疗中使用抗惊厥药是合理的。实验室和临床试验的积极结果进一步支持了这种使用。卡马西平是在临床试验中研究的此类药物中的第一种，并且在治疗神经性疼痛方面使用时间最长。临床试验数据支持其用于治疗三叉神经痛，但治疗糖尿病性神经病的数据令人信服。新型抗惊厥药的使用标志着神经性疼痛治疗的新纪元。加巴喷丁已证明有效，特别是在痛苦的糖尿病性神经病和带状疱疹后神经痛中。据报道，拉莫三嗪可有效缓解其他治疗方法难治的三叉神经痛，HIV神经病和中风后疼痛。苯妥英临床试验的结果是模棱两可的。Zonisamide的作用机制表明，它将有效控制神经性疼痛症状。其他抗惊厥药，包括劳拉西泮，丙戊酸，托吡酯和替加滨，也正在研究中。轶事经验为奥卡西平和左乙拉西坦治疗神经性疼痛的研究提供了支持。支持抗惊厥药治疗此类疼痛疗效的证据正在不断发展。其他临床试验应提供信息，以更好地定义其在神经性疼痛中的作用。

BACKGROUND & AIMS: :1. Succinimide derivatives can be either convulsant (tetramethylsuccinimide (TMS)), or anticonvulsant (ethosuximide (ES); alpha-methyl-alpha-phenylsuccinimide (MPS)). ES, an anticonvulsant succinimide, has previously been shown to block calcium currents of thalamic neurones, while the convulsant succinimide TMS blocks gamma-aminobutyric acid (GABA) responses in a similar fashion to the convulsant pentylenetetrazol (PTZ). 2. Using voltage-clamp techniques, we analysed the effects of the anticonvulsant succinimides ES and MPS and the convulsants TMS and PTZ on calcium currents of acutely isolated thalamic relay neurones of the rat. 3. MPS and ES reduced low-threshold calcium current (LTCC) in a voltage-dependent manner, without affecting steady-state inactivation. MPS was less potent than ES (IC50 of 1100 vs 200 microM) but greater in efficacy (100% maximal reduction vs 40% for ES). 4. PTZ had no effect on calcium currents, and TMS only reduced LTCC at very high concentrations, and did not occlude MPS effects when applied concurrently. 5. These results, which demonstrate that anticonvulsant, but not convulsant, succinimides block LTCC, provide additional support for the hypothesis that LTCC reduction is a mechanism of action of the anticonvulsant succinimides related to their effects in petit mal epilepsy.

背景与目标： : 1。琥珀酰亚胺衍生物可以是惊厥剂 (四甲基琥珀酰亚胺 (TMS))，也可以是抗惊厥剂 (ethosuximide (ES); Α-甲基-α-苯基琥珀酰亚胺 (MPS))。ES是一种抗惊厥药琥珀酰亚胺，以前已被证明可以阻断丘脑神经元的钙电流，而惊厥药琥珀酰亚胺TMS则以与惊厥药戊四氮 (PTZ) 相似的方式阻断 γ-氨基丁酸 (GABA) 反应。2.使用电压钳技术，我们分析了抗惊厥药琥珀酰亚胺ES和MPS以及惊厥药TMS和PTZ对大鼠急性分离的丘脑中继神经元钙电流的影响。3. MPS和ES以电压依赖性方式降低了低阈值钙电流 (LTCC)，而不影响稳态失活。MPS的效力低于ES (1100的IC50与200的microM)，但效力更高 (100% 的最大降低与ES的40%)。4. PTZ对钙电流没有影响，TMS仅在非常高的浓度下降低LTCC，同时使用时不会抑制MPS效应。5.这些结果表明抗惊厥药而非惊厥药琥珀酰亚胺阻断LTCC，为LTCC减少是抗惊厥药琥珀酰亚胺的作用机制与它们在小癫痫中的作用有关的假说提供了额外的支持。

BACKGROUND & AIMS: BACKGROUND:Restless legs syndrome (RLS) is a sensory motor disorder characterized by a distressing urge to move the legs and sometimes also other parts of the body usually accompanied by a marked sense of discomfort or pain in the leg or other affected body part. Many treatments have been used to minimize the discomfort of the disease, among them the anticonvulsant therapy. AIM:This review aims to evaluate the efficacy and safety of anticonvulsant treatment for idiopathic RLS. METHOD:Systematic review of randomized or quasi-randomized, double blind trials on anticonvulsant treatment for RLS. OUTCOMES:relief of RLS symptoms, subjective and objective sleep quality, quality of life, and adverse events associated with the treatments. RESULTS:A total of 231 patients were randomized in three cross over studies and one parallel study. Three studies with carbamazepine, one with sodium valproate, and one with gabapentin, and they were very heterogeneous so we could not perform a meta-analysis. CONCLUSIONS:There is no scientific evidence on RLS treatment with anticonvulsants for clinical practice.

背景与目标：

BACKGROUND & AIMS: :According to data found in the literature, children born to epileptic mothers on anticonvulsant therapy have an increased perinatal mortality rate, namely 2-3 times the average. The congenital malformations attributed to anticonvulsant drugs cannot fully account for this high mortality rate. A case is described in which a severe bleeding disorder manifested itself in successive offspring. A discussion follows in which this defect in blood coagulation in the newborn and the role played by vitamin K is considered as representing an important and preventable cause of neonatal death and morbidity. Other features of the postnatal syndrome (CNS depression, congenital heart disease, withdrawal symptoms, anemia) are mentioned in the case report. Suggested preventative measures employing vitamin K, folic acid and vitamin D are briefly discussed.

背景与目标： : 根据文献中发现的数据，抗惊厥疗法的癫痫母亲所生的孩子围产期死亡率增加，是平均水平的2-3倍。归因于抗惊厥药物的先天性畸形不能完全解释这种高死亡率。描述了一个案例，其中严重的出血性疾病在连续的后代中表现出来。随后进行了讨论，其中新生儿的凝血缺陷和维生素k的作用被认为是新生儿死亡和发病率的重要且可预防的原因。病例报告中提到了产后综合征的其他特征 (中枢神经系统抑郁症，先天性心脏病，戒断症状，贫血)。简要讨论了使用维生素k，叶酸和维生素d的建议预防措施。

BACKGROUND & AIMS: :Low-threshold calcium current (LTCC) in thalamic neurons is important in generation of normal thalamocortical rhythms, and may be involved in the genesis of abnormal activities such as spike-wave discharges that characterize petit mal epilepsy. Ethosuximide and dimethadione, anticonvulsants effective in petit mal, reduced the LTCC when applied to thalamic neurons at clinically relevant concentrations. Therapeutic concentrations of phenytoin and carbamazepine, drugs ineffective in the control of petit mal, had minimal effects on calcium conductances. Reduction in LTCC may be an important mechanism of action by which specific petit mal anticonvulsants depress spike-wave activity.

背景与目标： : 丘脑神经元中的低阈值钙电流 (LTCC) 在正常丘脑皮质节律的产生中很重要，并且可能参与异常活动的发生，例如表征小癫痫的尖峰波放电。Ethosuximide和dimethadione，对小动物有效的抗惊厥药，当以临床相关浓度应用于丘脑神经元时，会降低LTCC。苯妥英和卡马西平的治疗浓度对控制小剂量无效的药物对钙电导的影响很小。减少LTCC可能是一种重要的作用机制，通过这种作用，特定的小抗惊厥药可抑制尖峰波活性。

BACKGROUND & AIMS: BACKGROUND AND PURPOSE:Prophylactic anticonvulsants are routinely prescribed in the acute setting for intracerebral hemorrhage (ICH) patients, but some studies have reported an association with worse outcomes. We sought to characterize the prevalence and predictors of prophylactic anticonvulsant administration after ICH as well as guideline adherence. We also sought to determine whether prophylactic anticonvulsants were independently associated with poor outcome. METHODS:We performed a retrospective study of primary ICH in our two academic centers. We used a propensity matching approach to make treated and non-treated groups comparable. We conducted multiple logistic regression analysis to identify independent predictors of prophylactic anticonvulsant initiation and its association with poor outcome as measured by modified Rankin score. RESULTS:We identified 610 patients with primary ICH, of whom 98 were started on prophylactic anticonvulsants. Levetiracetam (97%) was most commonly prescribed. Age (OR 0.97, 95% CI 0.95-0.99, p < .001), lobar location (OR 2.94, 95% CI 1.76-4.91, p < .001), higher initial National Institutes of Health Stroke Scale (NIHSS) score (OR 2.31, 95% CI 1.40-3.79, p = .001), craniotomy (OR 3.06, 95% CI 1.51-6.20, p = .002), and prior ICH (OR 2.36, 95% CI 1.10-5.07, p = .028) were independently associated with prophylactic anticonvulsant initiation. Prophylactic anticonvulsant use was not associated with worse functional outcome [modified Rankin score (mRS) 4-6] at hospital discharge or with increased case-fatality. There was no difference in prescribing patterns after 2010 guideline publication. DISCUSSION:Levetiracetam was routinely prescribed following ICH and was not associated with worse outcomes. Future investigations should examine the effect of prophylactic levetiracetam on cost and neuropsychological outcomes as well as the role of continuous EEG in identifying subclinical seizures.

背景与目标：

BACKGROUND & AIMS: Drug-induced systemic lupus erythematosus (SLE)-like syndromes in children are most commonly associated with the administration of ethosuximide, diphenylhydantoin, and trimethadione. Five children receiving ethosuximide who presented with syndromes suggestive of SLE were studied. Each and fever, malar rash, arthritis, and lymphadenopathy. Two children had pleural effusions and another developed myocarditis and pericarditis. Three patients had anti-DNA antibodies associated with low serum C3. In four of five children symptoms disappeared with the discontinuation of ethosuximide; two of these continue to have antinuclear antibodies (ANA). One child continues to have active SLE with nephritis. A group of 101 children from a seizure clinic were tested for the presence of ANA. ANA were found in 14 of 70 children receiving ethosuximide and/or diphenylhydantoin; 2 of 14 had anti-DNA antibodies. Serum ANA titers in the drug-induced SLE group did not differ significantly from those of the asymptomatic seizure patients. ANA were also present in 5 of 23 children receiving phenobarbital only. The induction of ANA by phenobarbital is a possible hypothesis. Quantitative immunoglobulins and C3 were not significantly altered in the asymptomatic children with ANA. Follow-up studies at ten months showed no asymptomatic child with ANA to have developed clinical with ANA to have developed clinical evidence of SLE. This study suggests that asymptomatic children who develop ANA should have careful observation, but need not have their anticonvulsants discontinued.

背景与目标： 儿童药物诱导的系统性红斑狼疮 (SLE) 样综合征最常见的是使用乙硫胺，二苯乙内酰脲和三美甲二酮。研究了五名接受ethosuximide的儿童，他们出现了提示SLE的综合征。每个发热，斑疹，关节炎和淋巴结肿大。两个孩子有胸腔积液，另一个则发展为心肌炎和心包炎。三名患者的抗DNA抗体与低血清c3相关。在五名儿童中，有四名症状随着ethosuximide的停用而消失; 其中两个继续具有抗核抗体 (ANA)。一名儿童继续患有活动性系统性红斑狼疮并肾炎。对来自癫痫发作诊所的101名儿童进行了ANA的测试。在接受乙硫胺和/或二苯乙内酰脲的70名儿童中，有14名发现了ANA; 14个中有2个具有抗DNA抗体。药物诱导的SLE组的血清ANA滴度与无症状癫痫患者的血清ANA滴度无显着差异。仅接受苯巴比妥治疗的23名儿童中有5名也存在ANA。苯巴比妥诱导ANA是一个可能的假设。在无症状的ANA儿童中，定量免疫球蛋白和C3没有显着改变。10个月的随访研究显示，没有无症状的ANA患儿发展为临床的ANA并发展为SLE的临床证据。这项研究表明，患有ANA的无症状儿童应仔细观察，但不必停用抗惊厥药。

BACKGROUND & AIMS: :The sensitivity to anticonvulsants and anesthetics of Ca(2+) currents arising from alpha1G and alpha1H subunits was examined in stably transfected HEK293 cells. For comparison, in some cases blocking effects on dorsal root ganglion (DRG) T currents were also examined under identical ionic conditions. The anticonvulsant, phenytoin, which partially blocks DRG T current, blocked alpha1G current completely but with weaker affinity ( approximately 140 microM). Among different cells, alpha1H current exhibited either of two responses to phenytoin. In one subpopulation of cells, phenytoin produced a partial, higher affinity block (IC(50) approximately 7.2 microM, maximum block approximately 43%) similar to that in DRG neurons. In other cells, phenytoin produced complete, but lower affinity, blockade (IC(50) approximately 138 microM, maximum block approximately 89%). Another anticonvulsant, alpha-methyl-alpha-phenylsuccinimide (MPS), blocked DRG current partially, but blocked both alpha1G and alpha1H currents completely with weaker affinity ( approximately 1.7 mM). These data suggest that higher affinity blockade of T-type currents by phenytoin and MPS may require additional regulatory factors that can contribute to native T-type channels. In contrast, anesthetics blocked all T current variants similarly and completely. Block of alpha1G current by anesthetics had the following order of potency: propofol (IC(50) approximately 20.5 microM) > etomidate ( approximately 161 microM) = octanol ( approximately 160 microM) > isoflurane ( approximately 277 microM) > ketamine ( approximately 1.2 mM), comparable with results on DRG T currents. Barbiturates completly blocked alpha1G currents with potency [thiopental ( approximately 280 microM), pentobarbital ( approximately 310 microM), phenobarbital ( approximately 1.54 mM)] similar to that in DRG cells. The effects of propofol, octanol, and pentobarbital on alpha1H currents were indistinguishable from effects on alpha1G currents.

背景与目标： : 在稳定转染的HEK293细胞中检查了对 α1g和 α1h亚基引起的Ca(2) 电流的抗惊厥药和麻醉药的敏感性。为了进行比较，在某些情况下，还在相同的离子条件下检查了对背根神经节 (DRG) T电流的阻断作用。部分阻断DRG T电流的抗惊厥剂苯妥英完全阻断 α1g电流，但亲和力较弱 (约140微米)。在不同的细胞中，α1h电流表现出对苯妥英的两种反应之一。在一个细胞亚群中，苯妥英产生与DRG神经元相似的部分较高亲和力阻滞 (IC(50) 约7.2微米，最大阻滞约43%)。在其他细胞中，苯妥英产生完全但较低的亲和力阻断 (IC(50) 约138微米，最大阻断约89%)。另一种抗惊厥药 α-甲基-α-苯基琥珀酰亚胺 (MPS) 部分阻断DRG电流，但以较弱的亲和力 (约1.7 mM) 完全阻断 α1g和 α1h电流。这些数据表明，苯妥英和MPS对T型电流的更高亲和力阻断可能需要其他可能有助于天然T型通道的调节因素。相反，麻醉药相似且完全地阻断了所有T电流变体。麻醉剂阻断 α1g电流具有以下效力顺序: 丙泊酚 (IC(50) 约20.5微米)> 依托咪酯 (约161微米) = 辛醇 (约160微米)> 异氟烷 (约277微米)> 氯胺酮 (约1.2毫米)，与DRG T电流的结果相当。巴比妥酸盐完全阻断 α1g电流，其效力 [硫喷妥钠 (约280微米)，戊巴比妥 (约310微米)，苯巴比妥 (约1.54毫米)] 类似于DRG细胞。异丙酚，辛醇和戊巴比妥对 α1h电流的影响与对 α1g电流的影响没有区别。

BACKGROUND & AIMS: We describe a new instrument for use in assay of therpeutic drugs in serum by "high-performance" liquid chromatography, the "FAST-LC" system (Technicon). Serum samples are aspirated directly into the unit, extracted with solvent, and the evaporated and redissolved extract is injected onto a chromatographic column. We illustrate the performance of the system by assays in serum for theophylline and four anticonvulsants (primidone, phenobarbital, phenytoin, and carbamazepine) plus two of their active metabolites (phenylethylmalonamide and carbamazepine epoxide). For theophylline, final chromatograms are monitored at 270 nm, at analysis rates of 10/h. Concentration and absorbance are linearly related from 0 to 130 mg of theophylline per liter. For the anticonvulsants, chromatograms are monitored at 200 nm, at analysis rates of 7.5/h. The six individual determinations are each linear beyond the therapeutic range. For both drug panels, day-to-day CV's were 4 to 6%. Results correlate well with those by enzyme immunoassay. A total sample volume of 150 microL is required.

背景与目标： 我们描述了一种用于通过 “高效” 液相色谱法测定血清中治疗药物的新仪器，即 “FAST-LC” 系统 (Technicon)。将血清样品直接吸入装置，用溶剂提取，然后将蒸发和再溶解的提取物注入色谱柱。我们通过测定血清中的茶碱和四种抗惊厥药 (扑米酮，苯巴比妥，苯妥英钠和卡马西平) 及其两种活性代谢物 (苯乙基丙隆酰胺和卡马西平环氧化物) 来说明系统的性能。对于茶碱，在270 nm下以10/h的分析速率监测最终色谱图。浓度和吸光度从0至130毫克茶碱每升线性相关。对于抗惊厥药，在200 nm下以7.5/h的分析速率监测色谱图。六个单独的测定都是超出治疗范围的线性。对于两个药物小组，日常CV为4到6%。结果与酶免疫分析结果具有良好的相关性。需要150 microL的总样品量。

BACKGROUND & AIMS: :This study evaluated trends in resource use and prescription patterns in patients with active epilepsy over a 10-year period at the same outpatient clinic of a German epilepsy center. We analyzed a cross-sectional patient sample of consecutive adults with active epilepsy over a 3-month period in 2013 and compared them with equally acquired data from the years 2003 and 2008. Using validated patient questionnaires, data on socioeconomic status, course of epilepsy, as well as direct and indirect costs were recorded. A total of 198 patients (mean age: 39.6±15.0years, 49.5% male) were enrolled and compared with our previous assessments in 2003 (n=101) and 2008 (n=151). In the 2013 cohort, 75.8% of the patients had focal epilepsy, and the majority were taking antiepileptic drugs (AEDs) (39.9% monotherapy, 59.1% polytherapy). We calculated epilepsy-specific costs of €3674 per three months per patient. Direct medical costs were mainly due to anticonvulsants (20.9% of total direct costs) and to hospitalization (20.8% of total direct costs). The proportion of enzyme-inducing anticonvulsants and 'old' AEDs decreased between 2003 and 2013. Indirect costs of €1795 in 2013 were mainly due to early retirement (55.0% of total indirect costs), unemployment (26.5%), and days off due to seizures (18.2%). In contrast to our previous findings from 2003 and 2008, our data show a stagnating cost increase with slightly reduced total costs and balanced direct and indirect costs in patients with active epilepsy. These findings are accompanied by an ongoing cost-neutral increase in the prescription of 'newer' and non-enzyme-inducing AEDs. However, the number and distribution of indirect cost components remained unchanged.

背景与目标： : 这项研究评估了德国癫痫中心同一门诊10年内活动性癫痫患者的资源使用和处方模式的趋势。我们分析了2013年3个月内连续患有活动性癫痫的成年人的横断面患者样本，并将其与来自2003年和2008的同等获取数据进行了比较。使用经过验证的患者问卷，记录了有关社会经济状况，癫痫病程以及直接和间接费用的数据。总共纳入了198例患者 (平均年龄: 39.6 ± 15.0岁，49.5% 例男性)，并与我们以前的评估2003年 (n = 101) 和2008 (n = 151) 进行了比较。在2013队列中，75.8% 的患者患有局灶性癫痫，大多数患者服用抗癫痫药 (aed) (39.9% 单药治疗，59.1% 多药治疗)。我们计算了每位患者每三个月3674欧元的癫痫特定费用。直接医疗费用主要是由于抗惊厥药 (占总直接费用的20.9%) 和住院费用 (占总直接费用的20.8%)。诱导酶的抗惊厥药和 “旧” aed的比例2003年和2013下降。2013年1795欧元的间接费用主要是由于提前退休 (占总间接费用的55.0%)，失业 (26.5%) 和因癫痫发作而休假 (18.2%)。与2003年和2008之前的发现相反，我们的数据显示，活动性癫痫患者的成本增长停滞，总成本略有降低，直接和间接成本平衡。这些发现伴随着 “新” 和非酶诱导aed处方的成本中性增加。但是，间接成本组成部分的数量和分布保持不变。

BACKGROUND & AIMS: From their studies of epileptic children, the authors found that barbiturate anticonvulsants have several unexpected psychologic and behavioral effects. They suggest that clinicians dealing with depression in epileptic patients consider the possibility that barbiturate anticonvulsants may be a contributing factor.

背景与目标： 通过对癫痫儿童的研究，作者发现巴比妥酸盐抗惊厥药具有几种意想不到的心理和行为影响。他们建议治疗癫痫患者抑郁症的临床医生考虑巴比妥酸盐抗惊厥药可能是一个促成因素。

BACKGROUND & AIMS: The authors investigated 37 patients with established focal epilepsy in terms of the antiepileptic drug (AED) blood levels needed to achieve control or significant abatement of seizures; then they examined the patients by computerized axial tomography (CAT) and grouped them according as they did or did not show evidence of an organic food lesion of the brain. Statistical elaboration of the data revealed that CAT-positive patients required significantly higher mean AED blood levels for clinical effectiveness than did CAT-negative patients; also, single drugs failed to produce control at any plasma level, necessitating recourse to multidrug regimes, significantly more often in the CAT-positive than in the CAT-negative patient group. In the discussion the authors examine the possible reasons for the observed difference of therapeutic responses.

背景与目标： 作者调查了37例确定的局灶性癫痫患者的抗癫痫药 (AED) 血液水平，以实现控制或显着减轻癫痫发作; 然后，他们通过计算机轴向断层扫描 (CAT) 检查了患者，并根据他们是否显示出脑部有机食物病变的证据对他们进行了分组。数据的统计说明显示，CAT阳性患者比CAT阴性患者需要更高的平均AED血液水平才能达到临床效果; 此外，单一药物无法在任何血浆水平产生控制，因此需要诉诸多药方案，与猫阴性患者组相比，猫阳性患者组的发生率明显更高。在讨论中，作者研究了观察到的治疗反应差异的可能原因。

BACKGROUND & AIMS: :Anticonvulsants are becoming increasingly popular for the management of psychiatric and neuropsychiatric syndromes. This may be related to antikindling properties of these agents in addition to modulation of gamma-aminobutyric acid, serotonin, and other neurotransmitters. Treatment selection is complicated by the inconsistent availability of randomized controlled data among the growing range of choices. Moreover, generalization of psychiatric to neuropsychiatric applications of anticonvulsant treatments is not universally applicable. This paper reviews the use of newer anticonvulsants in the management of neuropsychiatric disorders, particularly aggression and agitation. The largest body of treatment data is available for valproic acid, which appears to be efficacious and well-tolerated in a wide range of neuropsychiatric disorders. Less consistent data are available for other medications. Further prospective studies are warranted to examine the use of these medications in neuropsychiatric populations.

背景与目标： : 抗惊厥药在治疗精神和神经精神综合征方面越来越受欢迎。除了调节 γ-氨基丁酸，5-羟色胺和其他神经递质外，这可能与这些药物的抗点燃特性有关。由于越来越多的选择中随机对照数据的可用性不一致，因此治疗选择变得复杂。此外，抗惊厥治疗的精神病学推广到神经精神病学应用并不普遍适用。本文回顾了新型抗惊厥药在神经精神疾病 (尤其攻击和躁动) 管理中的使用。丙戊酸的治疗数据最多，在各种神经精神疾病中似乎有效且耐受性良好。其他药物的数据不太一致。需要进一步的前瞻性研究来检查这些药物在神经精神病学人群中的使用。

BACKGROUND & AIMS: BACKGROUND:Fibromyalgia (FM) is a clinically well-defined chronic condition of unknown aetiology characterised by chronic widespread pain that often co-exists with sleep problems and fatigue. People often report high disability levels and poor health-related quality of life (HRQoL). Drug therapy focuses on reducing key symptoms and disability, and improving HRQoL. Anticonvulsants (antiepileptic drugs) are drugs frequently used for the treatment of chronic pain syndromes. OBJECTIVES:To assess the benefits and harms of anticonvulsants for treating FM symptoms. SEARCH METHODS:We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 8, 2013), MEDLINE (1966 to August 2013), PsycINFO (1966 to August 2013), SCOPUS (1980 to August 2013) and the reference lists of reviewed articles for published studies and www.clinicaltrials.gov (to August 2013) for unpublished trials. SELECTION CRITERIA:We selected randomised controlled trials of any formulation of anticonvulsants used for the treatment of people with FM of any age. DATA COLLECTION AND ANALYSIS:Two review authors independently extracted the data of all included studies and assessed the risks of bias of the studies. We resolved discrepancies by discussion. MAIN RESULTS:We included eight studies: five with pregabalin and one study each with gabapentin, lacosamide and levetiracetam. A total of 2480 people were included into anticonvulsants groups and 1099 people in placebo groups. The median therapy phase of the studies was 13 weeks. The amount and quality of evidence were insufficient to draw definite conclusions on the efficacy and safety of gabapentin, lacosamide and levetiracetam in FM. The amount and quality of evidence was sufficient to draw definite conclusions on the efficacy and safety of pregabalin in FM. Therefore, we focused on our interpretation of the evidence for pregabalin due to our greater certainty about its effects and its greater relevance to clinical practice. All pregabalin studies had a low risk of bias. Reporting a 50% or greater reduction in pain was more frequent with pregabalin use than with a placebo (risk ratio (RR) 1.59; 95% confidence interval (CI) 1.33 to 1.90; number needed to treat for an additional beneficial outcome (NNTB) 12; 95% CI 9 to 21). The number of people who reported being 'much' or 'very much' improved was higher with pregabalin than with placebo (RR 1.38; 95% CI 1.23 to 1.55; NNTB 9; 95% CI 7 to 15). Pregabalin did not substantially reduce fatigue (SMD -0.17; 95% CI -0.25 to -0.09; 2.7% absolute improvement on a 1 to 50 scale) compared with placebo. Pregabalin had a small benefit over placebo in reducing sleep problems by 6.2% fewer points on a scale of 0 to 100 (standardised mean difference (SMD) -0.35; 95% CI -0.43 to -0.27). The dropout rate due to adverse events was higher with pregabalin use than with placebo use (RR 1.68; 95% CI 1.36 to 2.07; number needed to treat for an additional harmful outcome (NNTH) 13; 95% CI 9 to 23). There was no significant difference in serious adverse events between pregabalin and placebo use (RR 1.03; 95% CI 0.71 to 1.49). Dizziness was reported as an adverse event more frequently with pregabalin use than with placebo use (RR 3.77; 95% CI 3.06 to 4.63; NNTH 4; 95% CI 3 to 5). AUTHORS' CONCLUSIONS:The anticonvulsant, pregabalin, demonstrated a small benefit over placebo in reducing pain and sleep problems. Pregabalin use was shown not to substantially reduce fatigue compared with placebo. Study dropout rates due to adverse events were higher with pregabalin use compared with placebo. Dizziness was a particularly frequent adverse event seen with pregabalin use. At the time of writing this review, pregabalin is the only anticonvulsant drug approved for treating FM in the US and in 25 other non-European countries. However, pregabalin has not been approved for treating FM in Europe. The amount and quality of evidence were insufficient to draw definite conclusions on the efficacy and safety of gabapentin, lacosamide and levetiracetam in FM.

背景与目标：