Berg A T, Langfitt J, Shinnar S, Vickrey B G, Sperling M R, Walczak T, Bazil C, Pacia S V, Spencer S S
BIOS, NIU, DeKalb, IL, USA.
Neurology. 2003 Jan 28;60(2):186-90. doi: 10.1212/01.wnl.0000031792.89992.ec.
Much remains unknown about the natural history of intractable localization-related epilepsy, including how long it typically takes before intractability becomes evident. This information could guide the design of future studies, resolve certain discrepancies in the literature, and provide more accurate information about long-term prognosis.
Individuals evaluated for resective surgery for refractory localization-related epilepsy were prospectively identified at the time of initial surgical evaluation at seven surgical centers (between 1996 and 2001). The latency time between onset of epilepsy and failure of second medication and history of remission (>/=1 year seizure-free) before surgical evaluation were examined with respect to age at onset, hippocampal atrophy, febrile seizures, and surgical site.
In the 333 patients included in the analysis, latency time was 9.1 years (range 0 to 48) and 26% reported a prior remission before surgery. A prior remission of >/=5 years was reported by 8.5% of study participants. Younger age at onset was strongly associated with longer latency time (p < 0.0001) and higher probability of past remission (p < 0.0001). In multivariable analyses, age at onset remained as the most important explanatory variable of both latency time and prior remission.
A substantial proportion of localization-related epilepsy may not become clearly intractable for many years after onset. This is especially true of epilepsy of childhood and early adolescent onset. If prospective studies confirm these findings and the underlying mechanisms behind these associations become understood, this raises the possibility of considering interventions that might interrupt such a process and some day prevent some forms of epilepsy from becoming intractable.
关于难治性局灶性相关性癫痫的自然病史仍有许多未知之处,包括通常需要多长时间才会出现难治性。这些信息可以指导未来研究的设计,解决文献中的某些分歧,并提供更准确的长期预后信息。
在七个手术中心(1996年至2001年)对因难治性局灶性相关性癫痫接受切除性手术评估的个体在初次手术评估时进行前瞻性识别。研究了癫痫发作开始至第二种药物治疗失败之间的潜伏期以及手术评估前的缓解史(≥1年无癫痫发作)与发病年龄、海马萎缩、热性惊厥和手术部位的关系。
纳入分析的333例患者中,潜伏期为9.1年(范围0至48年),26%的患者报告术前有过缓解。8.5%的研究参与者报告有过≥5年的缓解。发病年龄较小与潜伏期较长(p<0.0001)和既往缓解概率较高(p<0.0001)密切相关。在多变量分析中,发病年龄仍然是潜伏期和既往缓解的最重要解释变量。
相当一部分局灶性相关性癫痫在发病后多年可能不会明显变得难治。儿童期和青少年早期发病的癫痫尤其如此。如果前瞻性研究证实这些发现并理解这些关联背后的潜在机制,这就增加了考虑采取干预措施的可能性,这些措施可能会中断这一过程,并有朝一日预防某些形式的癫痫变得难治。