Is the underlying cause of epilepsy a major prognostic factor for recurrence?
Is the underlying cause of epilepsy a major prognostic factor for recurrence?
复制标题
DOI：
10.1212/wnl.51.5.1256
复制
发表时间：
1998-11-01
期刊：
影响因子：
9.9
通讯作者：
Baulac, M
中科院分区：
文献类型：
--
作者：
Semah, F;Picot, MC;Baulac, M
背景：我们研究了癫痫类型和癫痫综合征对癫痫复发的预后价值。在部分性癫痫患者中，我们着重于任何脑结构异常和致痫区域位置的预后价值。方法：共2,200例成人门诊患者被纳入一项以医院为基础的观察性调查，随访1至7年。22%的患者表现为全身性癫痫，62%为部分性癫痫，16%为未确定性癫痫。结果如下：82%的特发性全身性癫痫患者、35%的症状性部分性癫痫患者、45%的隐源性部分性癫痫患者和11%的海马硬化（HS）相关部分性癫痫患者实现了癫痫控制（>1年无癫痫发作）。颞叶癫痫（TLE）是最难治的部分性癫痫，只有20%的患者保持癫痫发作，而36%的额外TLE患者。在部分性癫痫中，HS、脑发育不全和双重病理（HS和另一种病变）与无癫痫患者的低比率相关（分别为11%、24%和3%）。在发作控制方面，额外TLE患者与TLE且无I-IS的患者之间无显著差异。结论：在成人中，部分性癫痫比特发性全身性癫痫更难治疗。在部分性癫痫患者中，致痫区的位置似乎不是决定性因素。脑异常，特别是HS，无论是单独或与其他病变相关，是一个主要的预后因素。
Background: We investigated the prognostic value of the type of epilepsies and epileptic syndromes for seizure recurrence. In patients with partial epilepsy, we focused on the prognostic value of any structural brain abnormality and of the location of the epileptogenic region. Methods: A total of 2,200 adult outpatients were included in a hospital-based observational survey, with a follow-up of 1 to 7 years. Twenty-two percent of the patients exhibited generalized epilepsy, 62% partial epilepsy, and 16% undetermined epilepsy. Results: Seizure control (>1 year without seizure) was achieved in 82% of patients who had idiopathic generalized epilepsy, 35% of those with symptomatic partial epilepsy, 45% of those with cryptogenic partial epilepsy, and 11% of those with partial epilepsy associated with hippocampal sclerosis (HS). Temporal lobe epilepsy (TLE) was the most refractory partial epilepsy, with only 20% of such patients remaining seizure free, compared with 36% of extra-TLE patients. In partial epilepsy, HS, cerebral dysgenesis, and dual pathology (HS and another lesion) were associated with a low rate of seizure-free patients (11%, 24%, and 3%, respectively). No significant difference in seizure control was found between patients with extra-TLE and those with TLE and no I-IS. Conclusions: In adults, partial epilepsy is more difficult to treat than idiopathic generalized epilepsy. In patients who have partial epilepsy, the location of the epileptogenic zone does not seem to be a determining factor. Brain abnormalities-especially HS, either alone or associated with another lesion-are a major prognostic factor.