新药
现有多种新型抗惊厥药物可用。研究表明，其中一些药物 [例如吡仑帕奈 (perampanel)] 作为单药治疗，对全面性起源和继发性全面性癫痫发作均有效。[125]French JA, Krauss GL, Wechsler RT, et al. Perampanel for tonic-clonic seizures in idiopathic generalized epilepsy: a randomized trial. Neurology. 2015 Sep 15;85(11):950-7.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567458/http://www.ncbi.nlm.nih.gov/pubmed/26296511?tool=bestpractice.com[126]Krauss GL, Perucca E, Ben-Menachem E, et al. Long-term safety of perampanel and seizure outcomes in refractory partial-onset seizures and secondarily generalized seizures: results from phase III extension study 307. Epilepsia. 2014 Jul;55(7):1058-68.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283992/http://www.ncbi.nlm.nih.gov/pubmed/24867391?tool=bestpractice.com 布瓦西坦 (Brivaracetam) 是获批用于治疗局灶性癫痫的最新药物，可降低继发性全面性癫痫发作的发生频率，[127]Moseley BD, Sperling MR, Asadi-Pooya AA, et al. Efficacy, safety, and tolerability of adjunctive brivaracetam for secondarily generalized tonic-clonic seizures: pooled results from three phase III studies. Epilepsy Res. 2016 Nov;127:179-85.https://www.sciencedirect.com/science/article/pii/S0920121116301644?via%3Dihubhttp://www.ncbi.nlm.nih.gov/pubmed/27608437?tool=bestpractice.com 并且可能对全面性癫痫发作有效。[128]Strzelczyk A, Klein KM, Willems LM, et al. Brivaracetam in the treatment of focal and idiopathic generalized epilepsies and of status epilepticus. Expert Rev Clin Pharmacol. 2016;9(5):637-45.http://www.ncbi.nlm.nih.gov/pubmed/26891946?tool=bestpractice.com 许多实验性药物目前正处在测试阶段，并可能在接下来的数年内投放市场。这些药物在全面强直-阵挛发作 (GTCS) 方面的疗效目前仍属未知。在美国，吡仑帕奈 (perampanel) 已被批准用作局灶性癫痫发作的辅助治疗。[129]US Food and Drug Administration (FDA). CDER new molecular entity (NME) and new biologic approvals calendar year 2012. Fycompa (perampanel). October 2012.在美国，托吡酯注射剂已被授予孤儿药地位，用于治疗住院癫痫患者的部分发作或 GTCS，或者用于治疗在急诊情况下无法口服托吡酯的癫痫患者。[130]US Food and Drug Administration (FDA). Orphan drug designations and approvals: topiramate injection. July 2013 [internet publication].http://www.accessdata.fda.gov/scripts/opdlisting/oopd/detailedIndex.cfm?cfgridkey=283909 美国食品药品监督管理局 (Food and Drug Administration) 授予地西泮鼻内给药制剂为孤儿药，用于急性反复癫痫发作的治疗，目前正对其开展一项关键性临床试验。
迷走神经刺激
对于已经对多种药物尝试产生抗药性且不适于进行手术的 GTCS 患者，迷走神经刺激是一种潜在的治疗选择（超说明书使用），尤其是在有症状或隐源性癫痫患者中。[131]Elliott RE, Morsi A, Tanweer O, et al. Efficacy of vagus nerve stimulation over time: review of 65 consecutive patients with treatment-resistant epilepsy treated with VNS >10years. Epilepsy Behav. 2011 Mar;20(3):478-83.http://www.ncbi.nlm.nih.gov/pubmed/21296622?tool=bestpractice.com[132]Englot DJ, Chang EF, Auguste KI. Vagus nerve stimulation for epilepsy: a meta-analysis of efficacy and predictors of response. J Neurosurg. 2011 Dec;115(6):1248-55.http://thejns.org/doi/full/10.3171/2011.7.JNS11977http://www.ncbi.nlm.nih.gov/pubmed/21838505?tool=bestpractice.com 两项系统评价发现，对于药物难治性癫痫并且不适合进行切除术治疗的患者，迷走神经刺激是一种有效、安全的辅助治疗。[132]Englot DJ, Chang EF, Auguste KI. Vagus nerve stimulation for epilepsy: a meta-analysis of efficacy and predictors of response. J Neurosurg. 2011 Dec;115(6):1248-55.http://thejns.org/doi/full/10.3171/2011.7.JNS11977http://www.ncbi.nlm.nih.gov/pubmed/21838505?tool=bestpractice.com[133]Englot DJ, Rolston JD, Wright CW, et al. Rates and predictors of seizure freedom with vagus nerve stimulation for intractable epilepsy neurosurgery. 2016 Sep;79(3):345-53.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884552/http://www.ncbi.nlm.nih.gov/pubmed/26645965?tool=bestpractice.com 然而，很少有病例能通过迷走神经刺激实现癫痫发作的完全治愈，[132]Englot DJ, Chang EF, Auguste KI. Vagus nerve stimulation for epilepsy: a meta-analysis of efficacy and predictors of response. J Neurosurg. 2011 Dec;115(6):1248-55.http://thejns.org/doi/full/10.3171/2011.7.JNS11977http://www.ncbi.nlm.nih.gov/pubmed/21838505?tool=bestpractice.com[133]Englot DJ, Rolston JD, Wright CW, et al. Rates and predictors of seizure freedom with vagus nerve stimulation for intractable epilepsy neurosurgery. 2016 Sep;79(3):345-53.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884552/http://www.ncbi.nlm.nih.gov/pubmed/26645965?tool=bestpractice.com 并且 1/4 的患者未从治疗中获益。[132]Englot DJ, Chang EF, Auguste KI. Vagus nerve stimulation for epilepsy: a meta-analysis of efficacy and predictors of response. J Neurosurg. 2011 Dec;115(6):1248-55.http://thejns.org/doi/full/10.3171/2011.7.JNS11977http://www.ncbi.nlm.nih.gov/pubmed/21838505?tool=bestpractice.com
癫痫发作检测设备
尽管仍处于研发阶段，但有正面的证据支持，将来植入设备将可在癫痫发作产生前对其进行检测与预防。目前，哪种癫痫发作类型有最佳治疗效果仍属未知。[134]Sun FT, Morrell MJ, Wharen RE Jr. Responsive cortical stimulation for the treatment of epilepsy. Neurotherapeutics. 2008 Jan;5(1):68-74.http://www.ncbi.nlm.nih.gov/pubmed/18164485?tool=bestpractice.com 感应式神经刺激器系统目前用于具有 1 至 2 个无法切除病灶的难治性癫痫患者，但不适用于全面性癫痫发作患者。[122]Jobst BC, Kapur R, Barkley GL, et al. Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas. Epilepsia. 2017 Jun;58(6):1005-14.https://onlinelibrary.wiley.com/doi/full/10.1111/epi.13739http://www.ncbi.nlm.nih.gov/pubmed/28387951?tool=bestpractice.com[123]Geller EB, Skarpaas TL, Gross RE, et al. Brain-responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy. Epilepsia. 2017 Jun;58(6):994-1004.https://onlinelibrary.wiley.com/doi/full/10.1111/epi.13740http://www.ncbi.nlm.nih.gov/pubmed/28398014?tool=bestpractice.com[135]Bergey GK, Morrell MJ, Mizrahi EM, et al. Long-term treatment with responsive brain stimulation in adults with refractory partial seizures. Neurology. 2015 Feb 24;84(8):810-7.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339127/http://www.ncbi.nlm.nih.gov/pubmed/25616485?tool=bestpractice.com[136]Heck CN, King-Stephens D, Massey AD, et al. Two-year seizure reduction in adults with medically intractable partial onset epilepsy treated with responsive neurostimulation: final results of the RNS System Pivotal trial. Epilepsia. 2014 Mar;55(3):432-41.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4233950/http://www.ncbi.nlm.nih.gov/pubmed/24621228?tool=bestpractice.com[137]Morrell MJ; RNS System in Epilepsy Study Group. Responsive cortical stimulation for the treatment of medically intractable partial epilepsy. Neurology. 2011 Sep 27;77(13):1295-304.http://www.ncbi.nlm.nih.gov/pubmed/21917777?tool=bestpractice.com
