Treatment of first tonic-clonic seizure does not improve the prognosis of epilepsy
Treatment of first tonic-clonic seizure does not improve the prognosis of epilepsy
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DOI：
10.1212/wnl.49.4.991
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发表时间：
1997-10-01
期刊：
影响因子：
9.9
通讯作者：
Viani, F
中科院分区：
文献类型：
--
作者：
Musicco, M;Beghi, E;Viani, F
人们普遍认为，在两次或两次以上癫痫发作后，患者应给予抗癫痫治疗，但对首次无端癫痫发作后患者的治疗仍有争议。在一项多中心、随机、开放试验中，首次强直-阵挛性癫痫发作的患者随机接受立即治疗（卡马西平、苯妥英、苯巴比妥或丙戊酸钠）或仅在另一次癫痫发作后接受治疗。随机分配至立即治疗组的215例患者中有52例（24%）和随机分配至延迟治疗组的204例患者中有85例（42%）在随访期间发生癫痫复发。年龄、苯二氮卓类药物急性治疗癫痫发作、远程病因和EEG异常是复发的重要预测因素。在立即接受治疗的患者中，87%的患者1年内没有癫痫发作，68%的患者2年内没有癫痫发作，而只有少数最初未经治疗的患者（83%和60%）达到了这些终点。首次癫痫发作后接受治疗的患者和癫痫发作复发后接受治疗的患者实现1年和2年无癫痫发作的时间依赖性概率相同。复发的预后预测变量与癫痫控制1年或2年的概率无显著相关性。抗惊厥药可降低首次强直阵挛性癫痫发作患者复发的风险;然而，50%未接受治疗的患者将永远不会发生第二次癫痫发作。此外，长期缓解的可能性不受首次癫痫发作治疗的影响。
It is widely agreed that after two or more seizures patients should be given antiepileptic treatment, but there is still controversy about the treatment of patients after a first unprovoked seizure. In a multicenter, randomized, open trial, patients with a first tonic-clonic seizure were randomized to immediate treatment (carbamazepine, phenytoin, phenobarbital, or sodium valproate) or to treatment only after another seizure. Fifty-two (24%) of the 215 patients randomized to immediate treatment and 85 (42%) of the 204 randomized to delayed treatment experienced seizure recurrence during follow-up. Age, acute treatment of the seizure with benzodiazepines, remote etiologic factors, and EEG abnormalities were significant predictors of relapse. Of the immediately treated patients, 87% had no seizures for a year and 68% had no seizures for 2 years, whereas only slightly fewer initially untreated patients (83% and 60%) achieved these endpoints. Patients treated after the first seizure and those treated after seizure relapse had the same time-dependent probability of achieving 1 and 2 seizure-free years. None of the variables that were prognostic predictors of relapse was significantly associated with the probability of having 1 or 2 years of seizure control. Anticonvulsants in patients presenting a first tonic-clonic seizure reduce the risk of relapse; however, 50% of patients who are not treated will never experience a second seizure. Moreover, the probability of long-term remission is not influenced by treatment of the first seizure.