Drug-resistant epilepsy in adults: Outcome trajectories after failure of two medications
Drug-resistant epilepsy in adults: Outcome trajectories after failure of two medications
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DOI：
10.1111/epi.13406
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发表时间：
2016-07-01
期刊：
影响因子：
5.6
通讯作者：
Heiman, Gary A.
中科院分区：
文献类型：
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作者：
Choi, Hyunmi;Hayat, Matthew J.;Heiman, Gary A.
目的检查成人癫痫患者发展为耐药性癫痫（DRE）的癫痫发作轨迹，并确定癫痫发作轨迹结果的预测因素。方法对因两种抗癫痫药物（AED）无效而在三级癫痫中心开始使用第三种抗癫痫药物的成人患者在医疗管理期间跟踪癫痫发作轨迹结果。癫痫发作轨迹分为四种模式之一：（1）持续癫痫发作的过程； (2) 波动过程； (3) 延迟获得癫痫发作（研究开始后癫痫发作延迟超过 12 个月，但患者仍保持癫痫发作）； (4) 尽早实现无癫痫发作（开始研究后 12 个月内）。使用多重序数逻辑回归模型来估计轨迹类别与临床因素之间的关联。结果 403 名成年患者符合资格标准。其中，212 人 (53%) 从未达到一年或以上的无癫痫发作期。 63 名患者 (16%) 的轨迹具有复杂的波动轨迹，62 名患者 (15%) 延迟发作无癫痫发作，66 名患者 (16%) 早期无癫痫发作。与更有利的结果轨迹相关的独立预测因素是癫痫类型和随访时间长度。具体来说，与颞叶局灶性癫痫患者相比，枕叶局灶性癫痫患者（OR 3.80，95%置信区间[CI] 1.00-14.51，p = 0.04）、普遍遗传（OR 3.23，95% CI 1.88-5.57，p < 0.0001）、不清楚的癫痫类型（OR 3.82， 95% CI 1.53-9.52，p < 0.005）以及局灶性和全身性癫痫（OR 11.73，95% CI 1.69-81.34，p = 0.01）明显更有可能经历更好的轨迹模式。 意义 对发生 DRE 的患者癫痫发作轨迹模式的检查显示，在观察期结束时，31% 的患者持续无癫痫发作。
ObjectiveTo examine the seizure trajectories of adults with epilepsy developing drug-resistant epilepsy (DRE) and to identify the predictors of seizure trajectory outcome.MethodsAdult patients failing two antiepileptic drugs (AEDs) due to inefficacy and starting their third AED at a tertiary epilepsy center were followed for seizure trajectory outcome during medical management. Seizure trajectories were categorized into one of four patterns: (1) course with constant seizures; (2) fluctuating course; (3) delayed attainment of seizure freedom (seizure freedom delayed for >12 months after start of the study, but patient stayed in seizure freedom); and (4) early attainment of seizure freedom (within 12 months of starting study). Multiple ordinal logistic regression models were used to estimate the association between trajectory categories and clinical factors.ResultsFour hundred three adult patients met the eligibility criteria. Of these, 212 (53%) never achieved a seizure-free period of a year or more. The trajectories of 63 patients (16%) had a complex fluctuating trajectory, 62 (15%) had delayed onset of seizure freedom, and 66 (16%) had an early seizure freedom. Independent predictors associated with more favorable outcome trajectories were epilepsy type and length of follow-up. Specifically, compared to patients with focal epilepsy of temporal lobe, patients with focal epilepsy of occipital lobe (OR 3.80, 95% confidence interval [CI] 1.00-14.51, p = 0.04), generalized genetic (OR 3.23, 95% CI 1.88-5.57, p < 0.0001), unclear epilepsy type (OR 3.82, 95% CI 1.53-9.52, p < 0.005), and both focal and generalized epilepsy(OR 11.73, 95% CI 1.69-81.34, p = 0.01) were significantly more likely to experience a better trajectory pattern.SignificanceExamination of patterns of seizure trajectory of patients with incident DRE showed that 31% were in continuous seizure freedom at the end of the observation period.