[首次全面性强直阵挛发作：复发及预后因素]

Falip-Centellas M, Rovira R M, Gratacós-Vinyola M, Lluís C, Pérez-Pérez S, Padró-Ubeda L

Servicio de Neurología, Unidad de Neuroinmulogía Clínica, Hospital General Universitari Vall d'Hebron, Barcelona, 08035, Espańa.

Rev Neurol. 2002;34(10):924-8.

OBJECTIVE

Previous epidemiologic studies have shown that around 5% of the population will suffer a tonic clonic seizure during their life. The aim of this study is to know how many and which of these people will suffer a second seizure and become epileptic.

PATIENTS AND METHODS

175 patients seen in the emergency department of the Vall d Hebron Hospital were included. They were divided in three groups according to the clinical suspicion of having had a seizure. Only the patients with low clinical suspicion and also normal EEG standard and EEG in sleep deprivation were excluded (16). The patients with previous episodes of lost of consciousness, previous episodes of possible mioclonias or absence were not excluded.

RESULTS

After a first tonic clonic seizure the patients who did not receive treatment present a risk of relapse of 66% followed two years and the patients treated 46%. The difference between two groups was statistically significant. Dividing the patients according to the type of seizure: primary generalised, partial or nor localised we did not find differences in the risk of relapse. Dividing the patients according to their etiology we found that the group of patients with provoked seizures was different from the rest groups: symptomatic, genetic or cryptogenic and idiopathic, who had equal risk of recurrence. We found that the presence of previous episodes of lost of consciousness, the clinical suspicion and, probably (we obtained nearly statistical signification) de EEG and the presence of previous mioclonias or absences were risk factors. Other factor like age at the moment of the first episode, febrile seizures, familiar history, antecedents of stroke, encephalitis, neurosurgery and dementia were not related with the risk of relapse.

CONCLUSIONS

With the exception of provoked seizures the rest of first tonic clonic seizures have a high risk of relapse (around 60 70%) and if they go with abnormal EEG, previous episodes of absences or mioclonias starting treatment must be considered.

目的

既往流行病学研究表明，约5%的人群一生中会经历一次强直阵挛发作。本研究的目的是了解这些人中有多少会再次发作并发展为癫痫，以及是哪些人。

患者与方法

纳入了在瓦尔德希伯伦医院急诊科就诊的175例患者。根据对是否发作的临床怀疑将他们分为三组。仅排除临床怀疑度低且脑电图标准及睡眠剥夺脑电图正常的患者（16例）。既往有意识丧失发作、既往可能有肌阵挛发作或失神发作的患者未被排除。

结果

首次强直阵挛发作后，未接受治疗的患者在两年后的复发风险为66%，接受治疗的患者为46%。两组之间的差异具有统计学意义。根据发作类型（原发性全面性、部分性或非局限性）对患者进行分组，我们未发现复发风险存在差异。根据病因对患者进行分组，我们发现诱发性发作患者组与其他组不同：症状性、遗传性或隐源性及特发性患者组的复发风险相同。我们发现既往有意识丧失发作、临床怀疑，可能还有脑电图（我们获得了接近统计学意义）以及既往有肌阵挛发作或失神发作是复发的危险因素。其他因素，如首次发作时的年龄、热性惊厥、家族史、中风、脑炎、神经外科手术和痴呆病史与复发风险无关。