目的：对癫痫患者添加拉考沙胺治疗后癫痫发作加重的病例进行分析。方法：收集空军军医大学西 京医院神经内科脑电监测中心收治的4例接受拉考沙胺治疗后出现癫痫发作加重的病例，分析其临床和电 生理特征。结果：4例患者的癫痫发作起始年龄为8～38岁，男性3例。均为局灶性起源癫痫且接受手术治 疗，2例为额叶胶质瘤切除术，1例为脑外伤后去骨瓣减压术，1例为药物难治性癫痫多次行癫痫灶切除。 4例患者术后接受拉考沙胺治疗的年龄为24～57岁，均出现原有局灶性癫痫发作加重，包括发作性头眼右 转、面部抽搐、失语和偏侧面部感觉异常发作等。结论：对于有颅脑手术史的癫痫患者，拉考沙胺可能加重 原有的局灶性癫痫发作。拉考沙胺导致癫痫发作加重的机制有待进一步明确。

To analyze cases of seizure exacerbation following the addition of lacosamide in epilepsy patients. Methods: Four cases with worsened seizures after lacosamide treatment were collected from the Video-EEG Monitoring Center at the Department of Neurology, Xijing Hospital affiliated to Air Force Medical University. Their clinical and electrophysiological characteristics were systematically analyzed. Results: The patients (3 males) had seizure onset ages ranging from 8 to 38 years. All exhibited focal epilepsy treated surgically: two underwent resection for frontal lobe gliomas, one received decompressive craniectomy post-traumatic brain injury, and another underwent multiple resective surgeries for drug-resistant epilepsy. When starting lacosamide therapy at ages 24～57 years postoperatively, all developed aggravated focal seizures manifesting as rightward head/eye deviation, facial twitching, aphasia, or contralateral facial paresthesia. Conclusion: Lacosamide may exacerbate preexisting focal seizures in patients with prior craniotomy histories. Further studies are needed to elucidate the mechanisms underlying its pro-seizure effects.