Kwong Karen L, Sung Wai Y, Wong Sik N, So Kwan T
Department of Pediatrics, Tuen Mun Hospital, Hong Kong, SAR China.
Pediatr Neurol. 2003 Jul;29(1):46-52. doi: 10.1016/s0887-8994(03)00028-6.
The goal of this study is identify early predictors of intractability in childhood epilepsy. A cohort of epileptic children living in the northwest sector of Hong Kong was prospectively identified and monitored. Treatment effect was analyzed at the last follow-up before July 1, 2000. Cases were patients who had an average of at least one unprovoked seizure per month during an observational period of at least 2 years. Controls were children having achieved at least 2 seizure-free years. Strong univariate association was observed between intractability and the following factors: high initial seizure frequency, remote symptomatic etiology, infantile spasms and mixed seizure types, abnormal neurologic status, history of status epilepticus, neonatal seizures, and early breakthrough attacks after treatment initiation. Independent predictors of intractability with multiple regression were abnormal neurodevelopmental status, symptomatic etiology, and more than three seizures in the second 6 months after treatment. Our study suggested that risk of developing intractable epilepsy might be predicted, to some extent, at the early course of illness in children with abnormal neurologic status and lack of early response to treatment.
本研究的目的是确定儿童癫痫难治性的早期预测因素。前瞻性地确定并监测了一群居住在香港西北部的癫痫儿童。在2000年7月1日之前的最后一次随访时分析治疗效果。病例为在至少2年的观察期内平均每月至少有一次无诱因发作的患者。对照为至少有2年无癫痫发作的儿童。难治性与以下因素之间存在显著的单变量关联：初始发作频率高、远隔症状性病因、婴儿痉挛和混合发作类型、神经功能状态异常、癫痫持续状态病史、新生儿惊厥以及治疗开始后的早期突破性发作。多因素回归分析得出难治性的独立预测因素为神经发育状态异常、症状性病因以及治疗后第二个6个月内发作超过3次。我们的研究表明，在神经功能状态异常且对治疗缺乏早期反应的儿童疾病早期过程中，在一定程度上可以预测发生难治性癫痫的风险。
