Antiepileptic drug withdrawal in patients with temporal lobe epilepsy undergoing presurgical video-EEG monitoring
Antiepileptic drug withdrawal in patients with temporal lobe epilepsy undergoing presurgical video-EEG monitoring
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DOI：
10.1046/j.1528-1157.2001.15100.x
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发表时间：
2001-02-01
期刊：
影响因子：
5.6
通讯作者：
Yiu, CH
中科院分区：
文献类型：
--
作者：
Yen, DJ;Chen, C;Yiu, CH
目的：探讨成人颞叶癫痫(TLE)患者在视频脑电监测中停用抗癫痫药物的情况。方法：1995~1997年间，收治102例难治性TLE患者，对其进行术前评估。对患者进行监测，持续的AEDs迅速减少，并在4-6天内停用。继续进行监测，直到记录到足够数量的缉获量。结果：患者有复杂部分性发作429例，平均每例4.8例，其中继发性泛发性发作156例(36.4%)。每例患者平均需要153.8小时(16-451h)完成监测。43例(48.3%)患者出现癫痫丛集，8例(9.0%)出现从未发生或多年未发生的全身性发作。然而，没有人演变为癫痫持续状态。71.9%的患者最常使用卡马西平，其次是丙戊酸盐和苯妥英钠。首次出现CPS时，即监测开始后平均77.2h，这3种AED的血清水平大多处于亚治疗状态，而不是最低水平。结论：急性AED停药有效地诱发了TLE患者术前视频脑电监测的癫痫发作。然而。近50%的患者有癫痫丛集或继发性全身性癫痫发作。首次CPS发生时，血清AED水平大多处于亚治疗状态。
Purpose: To investigate antiepileptic drug (AED) withdrawal during video-EEG monitoring in adult patients with temporal lobe epilepsy (TLE).Methods: Between 1995 and 1997, 102 consecutive patients with refractory TLE were admitted to the epilepsy monitoring unit for presurgical evaluation. Patients were monitored with ongoing AEDs being rapidly decreased and discontinued in 4-6 days. The monitoring was continued until sufficient numbers of seizures were recorded. Serum AED levels were checked at admission and after the first complex partial seizure (CPS).Results: In all, 89 patients had 429 CPSs (mean, 4.8 per patient), including 156 (36.4%) secondarily generalized. A mean of 153.8 h (16-451 h) was required for completing the monitoring in each patient. Forty-three (48.3%) patients experienced seizure clusters, and eight (9.0%) had generalized seizures that had never occurred or had been absent for years. However, none evolved to status epilepticus. Carbamazepine was the most commonly used AED in 71.9% of patients, followed by valproate and phenytoin. When the first CPS occurred, mean 77.2 h since the beginning of the monitoring, serum levels of these three AEDs were mostly subtherapeutic rather than minimal.Conclusions: Acute AED withdrawal effectively provoked seizures in TLE patients undergoing presurgical video-EEG monitoring. However. nearly 50% of patients had seizure clusters or secondarily generalized seizures. Serum AED levels were mostly subtherapeutic when the first CPS occurred.