Treatment Outcomes in Patients With Newly Diagnosed Epilepsy Treated With Established and New Antiepileptic Drugs A 30-Year Longitudinal Cohort Study
Treatment Outcomes in Patients With Newly Diagnosed Epilepsy Treated With Established and New Antiepileptic Drugs A 30-Year Longitudinal Cohort Study
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DOI：
10.1001/jamaneurol.2017.3949
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发表时间：
2018-03-01
期刊：
影响因子：
29
通讯作者：
Kwan, Patrick
中科院分区：
文献类型：
--
作者：
Chen, Zhibin;Brodie, Martin J.;Kwan, Patrick
重要性 2000 年发表的一项研究表明，超过三分之一的成人癫痫患者使用抗癫痫药物 (AED) 无法充分控制癫痫发作。本研究根据过去 20 年来推出的 12 多种新 AED 来评估总体治疗结果。 目的 评估新诊断和治疗的癫痫患者的长期治疗结果。 设计、环境和参与者 这项纵向观察性队列研究是在苏格兰格拉斯哥西部医院癫痫病房进行的。本次分析共纳入了 1795 名在 1982 年 7 月 1 日至 2012 年 10 月 31 日期间新接受 AED 治疗癫痫的患者。所有患者均接受至少 2 年随访（截至 2014 年 10 月 31 日）或直至死亡，以较早者为准。数据分析于 2015 年 3 月至 2016 年 5 月期间完成。 暴露 新诊断癫痫患者的抗癫痫药物治疗。 主要结果和措施 在研究期结束时评估癫痫发作控制情况。评估了每种 AED 治疗方案实现 1 年无癫痫发作的可能性。在对人口统计学和临床特征进行调整后，多变量模型评估了危险因素与 AED 治疗结果之间的关联。 结果 在纳入的 1795 名患者中，964 名 (53.7%) 为男性；964 名 (53.7%) 为男性；964 名 (53.7%) 为男性；964 名 (53.7%) 为男性；964 名 (53.7%) 为男性；964 名 (53.7%) 为男性；964 名 (53.7%) 为男性；964 名 (53.7%) 为男性；964 名 (53.7%) 为男性。中位年龄为 33 岁（范围：9-93 岁）。在研究期结束时，1144 名患者 (63.7%) 在前一年或更长时间内没有癫痫发作。在实现 1 年无癫痫发作的患者中，993 人 (86.8%) 正在接受单一疗法，1028 人 (89.9%) 通过第一个或第二个 AED 方案实现了癫痫发作控制。在所有患者中，有 906 名（50.5%）在使用初始 AED 后 1 年或更长时间内保持无癫痫发作。如果这种 AED 失败，第二个和第三个方案的无癫痫发作可能性分别增加 11.6% 和 4.4%。只有 2.12% 的患者通过随后的 AED 获得了最佳的癫痫发作控制。首次 AED 未能成功控制的癫痫患者对后续每种药物治疗方案均无反应的几率高出 1.73 倍（比值比，1.73；95% CI，1.56-1.91；P < .001）。 结论和相关性 尽管有许多具有不同作用机制的新 AED 可供使用，但新诊断癫痫患者的总体结果并未改善。大多数获得控制的患者都是通过第一次或第二次 AED 来实现的。每次尝试后续的 AED 治疗方案后，实现无癫痫发作的可能性都会大大降低。超过三分之一的患者患有仍未得到控制的癫痫症。
IMPORTANCE A study published in 2000 showed that more than one-third of adults with epilepsy have inadequate control of seizures with antiepileptic drugs (AEDs). This study evaluates overall treatment outcomes in light of the introduction of more than 1 dozen new AEDs in the past 2 decades.OBJECTIVE To assess long-term treatment outcome in patients with newly diagnosed and treated epilepsy.DESIGN, SETTING, AND PARTICIPANTS This longitudinal observational cohort study was conducted at the Epilepsy Unit of the Western Infirmary in Glasgow, Scotland. A total of 1795 individuals who were newly treated for epilepsy with AEDs between July 1, 1982, and October 31, 2012, were included in this analysis. All patients were followed up for a minimum of 2 years (until October 31, 2014) or until death, whichever came sooner. Data analysis was completed between March 2015 and May 2016.EXPOSURES Treatment with antiepileptic drugs for patients newly diagnosed with epilepsy.MAIN OUTCOMES AND MEASURES Seizure control was assessed at the end of the study period. Probability of achieving 1-year seizure freedom was estimated for each AED regimen prescribed. Multivariable models assessed the associations between risk factors and AED treatment outcome after adjustments were made for demographic and clinical characteristics.RESULTS Of the 1795 included patients, 964 (53.7%) were male; the median age was 33 years (range, 9-93 years). At the end of the study period, 1144 patients (63.7%) had been seizure free for the previous year or longer. Among those achieving 1-year seizure freedom, 993 (86.8%) were taking monotherapy and 1028 (89.9%) had achieved seizure control with the first or second AED regimens. Of the total patient pool, 906 (50.5%) remained seizure free for 1 year or longer with the initial AED. If this AED failed, the second and third regimens provided an additional 11.6% and 4.4% likelihoods of seizure freedom, respectively. Only 2.12% of patients attained optimal seizure control with subsequent AEDs. Epilepsy that was not successfully controlled with the first AED had 1.73 times greater odds of not responding to treatment for each subsequent medication regimen (odds ratio, 1.73; 95% CI, 1.56-1.91; P < .001).CONCLUSIONS AND RELEVANCE Despite the availability of many new AEDs with differing mechanisms of action, overall outcomes in newly diagnosed epilepsy have not improved. Most patients who attain control do so with the first or second AED. The probability of achieving seizure freedom diminishes substantially with each subsequent AED regimen tried. More than one-third of patients experience epilepsy that remains uncontrolled.