Seizure exacerbation with anti-seizure medications in adult patients with epilepsy.
Seizure exacerbation with anti-seizure medications in adult patients with epilepsy.
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DOI：
10.1016/j.eplepsyres.2022.106885
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发表时间：
2022-03
影响因子：
2.2
通讯作者：
Maheshwari A
中科院分区：
文献类型：
--
作者：
Jaramillo MA;Pham T;Kamrudin S;Khanna R;Maheshwari A
有许多与特定抗癫痫药物（asm）相关的癫痫发作加重的报道；然而，一个定量分析与明确定义参数癫痫发作加剧在门诊设置是缺乏的。这项回顾性研究检查了开始单一ASM的成年患者，并在治疗过程中跟踪患者的结果，定量评估矛盾发作加剧的发生率。在这项研究中，贝勒医学院综合癫痫中心的五位癫痫学家对门诊病人进行了为期10个月的评估。发作加重定义为急性发作开始后发作频率比基线发作频率增加至少2倍，并在急性发作停止后恢复到基线。将患者分为四类：(1)可能的asm诱发癫痫发作加重；(2)可能的asm诱发癫痫发作加重；(3)非asm诱发的癫痫发作加重；或(4)无癫痫发作加重。在总共236例开始急性发作的病例中，我们发现5.5%的患者经历了某种形式的癫痫发作加剧。然而，只有1.3%的患者可能有asm诱发的癫痫发作加剧。与先前的研究一致，我们的数据表明，成人癫痫发作加剧与asm的启动是罕见的。然而，需要更大样本量的进一步研究，以更好地了解哪些因素可能使患者易患潜在的药物诱导癫痫发作。
There are numerous reports of seizure exacerbation related to specific anti-seizure medications (ASMs); however, a quantitative analysis with clearly defined parameters for seizure exacerbation in an outpatient setting is lacking. This retrospective study examines adult patients starting a single ASM and follows patient outcomes over the course of treatment, with quantitative evaluation of the incidence of paradoxical seizure exacerbation. In this study, outpatient encounters with five epileptologists at the Baylor College of Medicine Comprehensive Epilepsy Center were evaluated over a 10-month period. Seizure exacerbation was defined as an increase in seizure frequency at least 2 times greater than the baseline seizure frequency after initiation of an ASM, with return to baseline after ASM discontinuation. Patients were stratified into four categories: (1) probable ASM-induced seizure exacerbation; (2) possible ASM-induced seizure exacerbation; (3) non-ASM induced seizure exacerbation; or (4) no seizure exacerbation. Out of a total of 236 encounters where an ASM was initiated, we found that 5.5% of patients experienced some form of seizure exacerbation. However, only 1.3% of patients had probable ASM-induced seizure exacerbation. Consistent with prior studies, our data indicate seizure exacerbation in adults is rare with the initiation of ASMs. However, further studies with a larger sample size are necessary to better understand what factors may predispose patients to potential medication-induced seizure exacerbation.
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