Early identification of refractory epilepsy.
Early identification of refractory epilepsy.
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DOI：
10.1056/nejm200002033420503
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发表时间：
2000-02-03
影响因子：
158.5
通讯作者：
Brodie, MJ
中科院分区：
文献类型：
--
作者：
Kwan, P;Brodie, MJ
背景：超过30%的癫痫患者通过药物治疗对癫痫发作的控制不足，但为什么会发生这种情况，是否可以预测，目前尚不清楚。我们研究了新诊断的癫痫患者对抗癫痫药物的反应，以确定与随后癫痫发作控制不良相关的因素。方法：我们前瞻性地研究了1984至1997年间在单一中心接受诊断、治疗和随访的525名患者(年龄从9岁到93岁)。癫痫被分类为特发性(有推测的遗传基础)、症状性(由结构异常引起)或隐匿性(由未知的潜在原因引起)。结果：在525例患者中，333例(63%)在抗癫痫药物治疗期间或停止治疗后仍未发作。有症状或不明原因的癫痫患者持续性癫痫的发生率高于特发性癫痫患者(40%比26%，P=0.004)，治疗前癫痫发作次数超过20次的患者高于发作次数较少的患者(51%比29%，P<0.05)。
Background: More than 30 percent of patients with epilepsy have inadequate control of seizures with drug therapy, but why this happens and whether it can be predicted are unknown. We studied the response to antiepileptic drugs in patients with newly diagnosed epilepsy to identify factors associated with subsequent poor control of seizures.Methods: We prospectively studied 525 patients (age, 9 to 93 years) who were given a diagnosis, treated, and followed up at a single center between 1984 and 1997. Epilepsy was classified as idiopathic (with a presumed genetic basis), symptomatic (resulting from a structural abnormality), or cryptogenic (resulting from an unknown underlying cause). Patients were considered to be seizure-free if they had not had any seizures for at least one year.Results: Among the 525 patients, 333 (63 percent) remained seizure-free during antiepileptic-drug treatment or after treatment was stopped. The prevalence of persistent seizures was higher in patients with symptomatic or cryptogenic epilepsy than in those with idiopathic epilepsy (40 percent vs. 26 percent, P=0.004) and in patients who had had more than 20 seizures before starting treatment than in those who had had fewer (51 percent vs. 29 percent, P