DISCONTINUING ANTIEPILEPTIC MEDICATION IN CHILDREN WITH EPILEPSY AFTER 2 YEARS WITHOUT SEIZURES - A PROSPECTIVE-STUDY
DISCONTINUING ANTIEPILEPTIC MEDICATION IN CHILDREN WITH EPILEPSY AFTER 2 YEARS WITHOUT SEIZURES - A PROSPECTIVE-STUDY
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DOI：
10.1056/nejm198510173131603
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发表时间：
1985-01-01
影响因子：
158.5
通讯作者：
FREEMAN, JM
中科院分区：
文献类型：
--
作者：
SHINNAR, S;VINING, EPG;FREEMAN, JM
88名患有各种原因癫痫的儿童停止了抗癫痫药物治疗，这些儿童已经2至4年没有癫痫发作。然后对受试者进行6个月至5年（平均22个月）的随访。66个国家（75%）仍然没有缉获。脑电图特征、癫痫发作类型和发病年龄是预测预后的重要因素。特定的脑电图特征（如是否存在减慢或尖峰）比简单的脑电图正常或异常分类更具预测性。有复杂部分性惊厥史且控制2年以上者预后较好（P < 0.05），有不典型热性惊厥史者预后较差（P < 0.05）。发病年龄越小也与预后越好相关（P < 0.05），但仅在伴有脑电图减慢的情况下。发病年龄与脑电图减慢、脑电图棘波、非典型热性惊厥、复杂部分性惊厥、脑电图减慢和脑电图改变的交互作用对预后的预测有统计学意义（P < 0.05）。我们的结论是，在大多数癫痫儿童谁已经免费的癫痫发作两年或两年以上，抗癫痫药物可以安全地停止，这是有可能合理地预测哪些儿童将保持免费的癫痫发作。
Antiepileptic medications were discontinued in 88 children with epilepsy of various causes who had been free of seizures for two to four years. The subjects were then followed for six months to five years (mean, 22 months). Sixty-six (75 per cent) remained free of seizures. Electroencephalographic characteristics, type of seizure, and age at onset were important in predicting outcome. Specific electroencephalographic features (such as the presence or absence of slowing or spikes) were more predictive than simple classification of an electroencephalogram as normal or abnormal. A history of complex partial seizures that had been controlled for two years carried a relatively favorable prognosis (P < 0.05), whereas a history of atypical febrile seizures carried a poor prognosis (P < 0.05). The variable of a younger age at onset was also associated with a better outcome (P < 0.05), but only if accompanied by electroencephalographic slowing. Altogether, six variables (the interaction of age at onset with electroencephalographic slowing, electroencephalographic spikes atypical febrile seizures, complex partial seizures, electroencephalographic slowing, and electroencephalographic change) were statistically significant (P < 0.05) in predicting outcome. We conclude that in most children with epilepsy who have been free of seizures for two or more years, antiepileptic medications can safely be discontinued, and that it is possible to predict reasonably well which children will remain free of seizures.