Evaluation of long-term antiepileptic drug use in patients with temporal lobe epilepsy: Assessment of risk factors for drug resistance and polypharmacy
Evaluation of long-term antiepileptic drug use in patients with temporal lobe epilepsy: Assessment of risk factors for drug resistance and polypharmacy
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DOI：
10.1016/j.seizure.2018.07.011
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发表时间：
2018-10-01
影响因子：
3
通讯作者：
Heuser, Kjell
中科院分区：
文献类型：
--
作者：
Bjorke, Agnes Balint;Nome, Cecilie Gjessing;Heuser, Kjell
目的：探讨颞叶癫痫患者耐药和多药的危险因素。方法：对治疗5年以上的颞叶癫痫患者进行抗癫痫药物使用及疗效问卷调查。采用Logistic回归模型分析危险因素。结果：纳入研究的135例患者中，65%为耐药，41%为多药。59%的患者报告首选抗癫痫药物疗效不佳，70%的患者报告二线治疗效果不佳。最常用的第一代抗癫痫药物与第二代抗癫痫药物的平均疗效相似。单因素回归分析显示，耐药与内侧颞叶硬化、18岁以下癫痫发作和无癫痫家族史之间存在显著关联。然而，多变量回归分析显示与任何人口统计学或临床特征无关。第1种抗癫痫药物治疗不成功使耐药风险增加18倍，第2种抗癫痫药物治疗效果差的风险增加9倍。疾病持续时间与耐药的年风险相关，分别为7%和5%。结论：初始药物治疗效果不佳是本研究中发现的唯一耐药早期危险因素。病程长会增加耐药和多药的风险。第二代抗癫痫药物对第一代药物的不良反应没有额外的作用。
Purpose: To evaluate risk factors for drug resistance and polypharmacy in patients with temporal lobe epilepsy.Methods: Patients with temporal lobe epilepsy, treated for more than 5 years, completed questionnaires on antiepileptic drug use and effect. Logistic regression models were used for analysis of risk factors.Results: Of 135 patients included in the study, 65% were classified as drug resistant and 41% identified as using polypharmacy. Poor effects associated with first-choice antiepileptic drug were reported by 59% of the patients, and 70% reported poor effects of second-line treatment. The most frequently used first-generation antiepileptic drugs had a similar mean effect to those of second-generation. Univariate regression analyses showed a significant association between drug resistance and mesial temporal sclerosis, seizure onset below 18 years, and lack of family history of epilepsy. However, multivariate regression analysis showed no association with any demographic or clinical features. Unsuccessful treatment with the first antiepileptic drug increased the risk of drug resistance by 18 times, and the risk of poor effect from the second antiepileptic drug by 9 times. Disease duration was associated with annual risk for drug resistance of 7% and for polypharmacy of 5%.Conclusions: A poor effect from initial pharmacotherapy is the only early risk factor for drug resistance found in this study. Long disease duration increases the risk of drug resistance and polypharmacy. Second-generation antiepileptic drugs provide no additional effect for poor responders to first-generation drugs.