Likelihood of seizure remission in an adult population with refractory epilepsy
Likelihood of seizure remission in an adult population with refractory epilepsy
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DOI：
10.1002/ana.21166
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发表时间：
2007-10-01
影响因子：
11.2
通讯作者：
French, Jacqueline A.
中科院分区：
文献类型：
--
作者：
Callaghan, Brian C.;Anand, Kishlay;French, Jacqueline A.
目的：我们的目的是确定符合难治性癫痫严格定义的成年患者缓解的可能性及其临床预测因素。我们还想调查治疗方案对缓解的影响。 方法：2000 年共确定了 246 名难治性癫痫患者（每月至少发作 1 次发作，且对至少 2 种抗癫痫药物没有积极反应），并随访 3 年。我们使用 Kaplan-Meier 方法估计实现 6 个月末期癫痫发作缓解的比率，并使用 Cox 回归分析来评估癫痫发作缓解的临床预测因子。结果：对于 A 病例，估计的 6 个月末期癫痫发作缓解率为 19%（95% 置信区间，14-26%），而当仅限于仅接受药物治疗的患者时，该值为 14%（95% 置信区间，10-21%）。缓解的阴性预测因素包括癫痫持续状态病史、难治性年龄较小、药物治疗失败的次数以及精神发育迟滞的存在。没有特定的药物与缓解显着相关，并且通常没有明确的干预措施导致最终缓解。解释：百分之十五（每年约 5%）的药物难治性癫痫人群获得了 6 个月的最终癫痫缓解。我们的结果表明，无论有多少抗癫痫药物治疗失败，该人群总有希望获得有意义的癫痫发作缓解。此外，我们还阐明了四种可以帮助癫痫病学家进行预测的临床预测因子。
Objective: We aimed to determine the likelihood of remission and its clinical predictors in adult patients meeting a strict definition of refractory epilepsy. We also wanted to investigate the influence of treatment regimen on remission.Methods: A total of 246 patients with treatment refractory epilepsy (having at least I seizure per month and having not responded positively to at least 2 antiepileptic drugs) were identified in 2000 and followed for 3 years. We used Kaplan-Meier methods to estimate the rate of achieving a 6-month terminal seizure remission and Cox regression analysis to evaluate clinical predictors for seizure remission.Results: The estimated 6-month terminal seizure remission rate was 19% (95% confidence interval, 14-26%) for A cases and 14% (95% confidence interval, 10-21%) when limited to those treated only with medication. Negative predictors for remission included a history of status epilepticus, younger age at intractability, number of failed drug therapies, and presence of mental retardation. No specific drug was significantly associated with remission, and frequently, no clear intervention led to terminal remission.Interpretation: Fifteen percent (approximately 5% per year) of a drug refractory epilepsy population obtained a 6-month terminal seizure remission. Our results signify that no matter how many antiepileptic drug therapies have failed, there is always hope of a meaningful seizure remission in this population. Furthermore, we have elucidated four clinical predictors that can aid the epileptologist in prognostication.