Dirençli Epilepsinin Medikal Tedavisi

Yazarlar

Özet

İlaca dirençli epilepsi, uygun dozda seçilen en az iki anti-nöbet ilaca (ANİ) rağmen nöbetlerin kontrol altına alınamaması olarak tanımlanmaktadır. Bu durum, yeni tanı konmuş hastaların yaklaşık %30’unda görülmekte ve prevalans oranları yıllar içinde gelişen yeni ANİ seçeneklerine rağmen anlamlı bir düşüş göstermemektedir. Klinik yönetimde temel öncelik, yanlış tanı, yetersiz dozaj veya tedavi uyumsuzluğu gibi nedenlerle ortaya çıkan "yalancı direnç" durumunu gerçek dirençten ayırt etmektir. İlaca dirençli epilepside tedavi stratejisi, hastanın nöbet tipi, spesifik epilepsi sendromu ve komorbiditeleri dikkate alınarak bireyselleştirilmelidir. Monoterapi denemelerinden sonra eklenen yardımcı tedavilerde (add-on), farklı etki mekanizmalarına sahip ilaçların kombinasyonuyla sinerjik etki hedeflenirken advers olay yükünün minimize edilmesi amaçlanır. Sonuç olarak, tam nöbetsizlik hedefine ulaşılamayan hastalarda dahi, nöbet sıklığının azaltılması ve yan etki profilinin optimize edilmesi yaşam kalitesini artırmak ve SUDEP gibi ciddi riskleri önlemek açısından kritik öneme sahiptir.

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21 Ocak 2026

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