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[特发性全身性癫痫和隐源性局灶性癫痫患儿的治疗终止]

[Treatment termination in children with idiopathic generalized epilepsy and cryptogenic focal epilepsy].

作者信息

Szwed-Białozyt Barbara, Marszał Elzbieta

机构信息

Katedra Pediatrii Klinika Neurologii Wieku Rozwojowego SAM Górnoślaskie Centrum Zdrowia Dziecka i Matki 40-752 Katowice, ul. Medyków 16.

出版信息

Przegl Lek. 2003;60 Suppl 1:5-9.

Abstract

The regression of epileptic attacks after a period for remission brings hope, particularly for a sick child's parents, for prompt treatment termination. This process, however, is related to the risk that the disease will recur. The paper is about the evolution of these changes in EEG and the assessment of disease recurrence in the course of treatment and upon therapy termination in patients taking valproic acid preparations (VPA) during idiopathic generalized epilepsy (IGE) and those taking carbamazepine (CBZ) preparations during cryptogenic focal epilepsy (CFE). A total of 121 patients in whom the attacks regressed as a result of monotherapy, were subjected to the assessment. The patients were classified into 2 groups: the first group of 52 patients treated with VPA (IGE), patients' age at the beginning of treatment--from 6 to 14, and the second group of 69 patients treated with CBZ (CFE), patients' age at the beginning of treatment--from 5 to 12. In patients suffering from IGE, an absence of attacks prevailed; while in those with CFE--the secondary generalized ones prevailed. The drug dosage reduction lasted from 3 to 24 months. The observation time at treatment termination was 2 years. 10 routine EEG tests were assessed in each patient. Attack regression was achieved mainly within 2 weeks, sporadically up to 6 months. In the initial EEG tests 4 (5.8%) of the patients with partial seizures had normal records, in the remaining 94.2%--the records were abnormal. Throughout the duration of the treatment, systematic improvement of EEG was noted in groups 1 and 2. At the commencement of the dosage reduction, the EEG irregularities were maintained in 9% of the patients with IGE and in 26% of those with CFE, increasing during reduction until the discontinuance of the medication. Frequency of attack recurrences was twice as large in the patients with IGE (mainly after the end of treatment) than in those with CFE, where they occurred during the reduction period and up to 3 months after the end of treatment. The recurrence of the disease in children of the first group was only preceded in one third by irregularities in EEG; on the contrary, it occurred in two thirds of the second group. The morphology of changes was non-homogeneous.

摘要

经过一段时间的缓解后癫痫发作消退,这带来了希望,尤其是对患病儿童的父母来说,有望迅速终止治疗。然而,这个过程与疾病复发的风险相关。本文探讨了这些患者脑电图(EEG)变化的演变情况,以及在特发性全身性癫痫(IGE)患者服用丙戊酸制剂(VPA)期间、隐源性局灶性癫痫(CFE)患者服用卡马西平(CBZ)制剂期间治疗过程中及治疗终止后疾病复发的评估。共有121例因单一疗法发作消退的患者接受了评估。患者被分为两组:第一组52例接受VPA治疗的IGE患者,治疗开始时年龄为6至14岁;第二组69例接受CBZ治疗的CFE患者,治疗开始时年龄为5至12岁。IGE患者中无发作情况较为普遍;而CFE患者中继发性全身性发作较为普遍。药物减量持续3至24个月。治疗终止后的观察时间为2年。每位患者评估10次常规脑电图检查。发作消退主要在2周内实现,偶尔长达6个月。在最初的脑电图检查中,部分发作患者中有4例(5.8%)记录正常,其余94.2%记录异常。在整个治疗期间,第1组和第2组脑电图均有系统性改善。在减量开始时,IGE患者中有9%、CFE患者中有26%脑电图仍有异常,在减量过程中直至停药异常情况增加。IGE患者发作复发频率是CFE患者的两倍(主要在治疗结束后),CFE患者发作复发发生在减量期及治疗结束后3个月内。第一组儿童疾病复发时,只有三分之一之前脑电图有异常;相反第二组有三分之二。变化的形态并不均匀。

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