The frequency of intractable seizures after stopping AEDs in seizure-free children with epilepsy
The frequency of intractable seizures after stopping AEDs in seizure-free children with epilepsy
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DOI：
10.1212/01.wnl.0000154517.82748.a7
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发表时间：
2005-03-22
期刊：
影响因子：
9.9
通讯作者：
Camfield, C
中科院分区：
文献类型：
--
作者：
Camfield, P;Camfield, C
背景：1至4年后，鼓励无癫痫发作的癫痫儿童停止每日抗癫痫药物（AED）治疗。大约70%是成功的。作者在一个以人群为基础的癫痫儿童队列中研究了AED治疗停止后难治性癫痫的频率。研究方法：新斯科舍省基于人群的癫痫队列用于识别停用AED但随后发生难治性癫痫的儿童。研究的所有患者（年龄1个月至16岁）在1977年至1985年期间发生癫痫，癫痫的特征为部分性或惊厥性癫痫发作，并进行了至少5年的随访评估（n = 367）。良性罗兰癫痫患者被排除。难治性定义为在随访审查的最后一年内每3个月发生一次或多次癫痫发作，或直至癫痫发作手术成功和最大耐受剂量的三种或更多种AED失败。结果：总体而言，71%（260/ 367）的合格儿童在1至4年内没有癫痫发作，并停止了AED治疗。在这一组中，70%的人在没有AED治疗的情况下仍然没有癫痫发作，但30%的人复发。只有3名复发的儿童后来发展为难治性癫痫。两名患者随后接受了颞叶切除术，一名成功，另一名仅部分成功（20年随访期）。第三例患者在停止AED治疗后持续7年顽固性癫痫，但最终进入缓解期。结论：大约1%的儿童谁成为免费的癫痫发作和停止抗癫痫药物治疗复发癫痫发作，不能再次控制药物。作者无法预测这一结果。目前尚不清楚如果不停用抗癫痫药物是否会发生类似的结果。
Background: After 1 to 4 years, seizure-free children with epilepsy are encouraged to stop daily antiepileptic drug (AED) treatment. Approximately 70% are successful. The authors examined how often intractable epilepsy follows discontinuation of AED treatment in a population- based cohort of children with epilepsy. Methods: The Nova Scotia population- based epilepsy cohort was used to identify children who discontinued AEDs but subsequently developed intractable epilepsy. All patients studied ( ages 1 month to 16 years) developed epilepsy between 1977 and 1985, had epilepsies characterized by partial or convulsive seizures, and had at least 5 years of follow-up evaluation ( n = 367). Those with benign rolandic epilepsy were excluded. Intractability was defined as one or more seizures every 3 months during the last year of follow-up review or until successful seizure surgery and failure of three or more AEDs at maximum tolerated doses. Results: Overall, 71% ( 260/ 367) of eligible children became free of seizure for 1 to 4 years and discontinued AED treatment. Of this group, 70% remained seizure- free without AED treatment, but 30% had recurrences. Only three children with recurrences later developed intractable epilepsy. Two then underwent a temporal lobectomy, one successful and one only partially successful ( 20- year follow- up periods). The third patient continued to have intractable epilepsy for 7 years after discontinuing AED treatment but eventually entered remission. Conclusion: Approximately 1% of children who became free of seizure and discontinued antiepileptic drug treatment had recurrent seizures that could not be controlled again with medication. The authors were unable to predict this outcome. It remains unclear whether a similar outcome would have occurred if antiepileptic drugs had not been discontinued.