Long-term seizure remission in childhood absence epilepsy: might initial treatment matter?
Long-term seizure remission in childhood absence epilepsy: might initial treatment matter?
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DOI：
10.1111/epi.12551
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发表时间：
2014-04
期刊：
影响因子：
5.6
通讯作者：
Blumenfeld H
中科院分区：
文献类型：
--
作者：
Berg AT;Levy SR;Testa FM;Blumenfeld H
检查儿童期缺失性癫痫（CAE）长期发作结果与初始治疗选择之间可能存在的关联。在初步诊断时前瞻性地招募CAE患儿，并在社区队列研究中进行随访。排除有惊厥发作、明显影像学异常或随访<5年的儿童。早期结果包括初始用药成功、早期缓解和耐药性。主要的长期结局是完全缓解，≥5年癫痫发作和无药物治疗。采用生存法进行分析。首用药为埃索辛胺（ESM） 41例（69%），丙戊酸（VPA） 18例（31%）。初始成功率分别为59% （ESM）和56% （VPA）。各组早期缓解和耐药情况相似。除了非典型脑电图特征(61% （VPA), 17% (ESM)）外，两组之间的临床特征无显著差异。接受ESM治疗的31名儿童（76%）和接受VPA治疗的7名儿童（39%）完全缓解（p=0.007）。有非典型脑电图特征的儿童与无非典型脑电图特征的儿童进入完全缓解的可能性较低（50%对71%，p=0.03）。在Cox回归中，与VPA相比，ESM与更高的完全缓解率相关（风险比(HR)=2.5, 95% CI 1.1-6.0, p=0.03）。非典型脑电图特征不能独立预测预后（p=0.15）。不管是否继续治疗，5年和10年的缓解在最初接受ESM治疗的儿童中比VPA更常见。这些发现与大鼠基因缺失模型的研究结果一致，并为ESM在儿童缺失癫痫中潜在的疾病调节作用的假设提供了初步证据。
Examine the possible association between long-term seizure outcome in childhood absence epilepsy (CAE) and the initial treatment choice. Children with CAE were prospectively recruited at initial diagnosis and followed in a community-based cohort study. Children presenting with convulsive seizures, significant imaging abnormalities or who were followed <5 years were excluded. Early outcomes included success of initial medication, early remission, and pharmacoresistance. The primary long-term outcome was complete remission, ≥5 years both seizure and medication-free. Survival methods were used for analyses. The first medication was Ethosuximde (ESM ) in 41 (69%) and Valproic acid (VPA) in 18 (31%). Initial success rates were 59% (ESM) and 56% (VPA). Early remission and pharmacoresistance were similar in each group. Apart from atypical EEG features (61% (VPA), 17% (ESM )), no clinical features varied substantially between the treatment groups. Complete remission occurred in 31 (76%) children treated with ESM and 7 (39%) who received VPA (p=0.007). Children with versus without atypical EEG features were less likely to enter complete remission (50% vs. 71%, p=0.03). In a Cox regression, ESM was associated with a higher rate of complete remission than VPA (Hazards ration (HR)=2.5, 95% CI 1.1-6.0, p=0.03). Atypical EEG features did not independently predict outcome (p=0.15). Five- and 10-year remission, regardless of continued treatment, occurred more often in children initially treated with ESM versus VPA . These findings are congruent with results of studies in genetic absence models in rats and provide preliminary evidence motivating a hypothesis regarding potential disease modifying effects of ESM in childhood absence epilepsy.
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DOI：
10.1056/nejmoa0902014
发表时间：
2010-03-04
期刊：
The New England journal of medicine
影响因子：
--
作者：
Glauser TA;Cnaan A;Shinnar S;Hirtz DG;Dlugos D;Masur D;Clark PO;Capparelli EV;Adamson PC;Childhood Absence Epilepsy Study Group
通讯作者：
Childhood Absence Epilepsy Study Group
DOI：
10.1016/0021-9681(79)90012-2
发表时间：
1979-01-01
期刊：
JOURNAL OF CHRONIC DISEASES
影响因子：
--
作者：
SACKETT, DL
通讯作者：
SACKETT, DL
影响因子：
14.5
作者：
Berg, Anne T.;Mathern, Gary W.;Levy, Susan R.
通讯作者：
Levy, Susan R.
影响因子：
5.6
作者：
Grosso, S;Galimberti, D;Balestri, P
通讯作者：
Balestri, P
影响因子：
5.6
作者：
Kwan, Patrick;Arzimanoglou, Alexis;French, Jacqueline
通讯作者：
French, Jacqueline