Kudo Tatsuya, Nishida Takuji, Yagi Kazuichi
National Epilepsy Center, Shizuoka Medical Institute of Neurological Disorders, Shizuoka, Japan.
Epilepsia. 2004;45 Suppl 8:26-32. doi: 10.1111/j.0013-9580.2004.458006.x.
To study factors associated with discontinuation of antiepileptic drugs (AEDs) in idiopathic generalized epilepsy (IGE) and symptomatic/cryptogenic localization-related epilepsy (S/CLRE) METHODS: For the IGE study, 71 patients who were able to discontinue their AED (discontinued-IGE group) were compared to 71 patients who continued AED therapy (continued-IGE group) and 20 patients with seizure relapse after discontinuing AED (relapsed-IGE group). For S/CLRE, 90 patients who were able to discontinue AED (discontinued-S/CLRE group) were compared to 90 patients who continued AED (continued-S/CLRE group) and 76 patients with benign childhood epilepsy with centrotemporal spikes who were able to discontinue AED (discontinued-BECTS group).
Compared to the continued-IGE group, the discontinued-IGE group showed a weaker seizure propensity, better response to AEDs, more frequent epileptiform discharge suppression, and lower frequency of generalized tonic-clonic seizures (GTCs). Compared to the relapse-IGE group, the discontinued-IGE group had more frequent epileptiform discharge suppression. The discontinued-S/CLRE group showed a weaker seizure propensity, better response to AEDs, more frequent epileptiform discharge suppression, and less frequent symptomatic signs compared to the continued-S/C LRE group. Notably, the age at epilepsy onset was not a critical factor for discontinuing AEDs in both IGE and S/CLRE. Although the discontinued-S/CLRE group had more frequent symptomatic signs, older age at epilepsy onset and less frequent epileptiform discharge suppression than the discontinued-BECTS group, no difference was found in seizure propensity and response to AEDs between the two groups.
Seizure propensity, epileptiform discharge, and response to AEDs should be considered to predict the possibility of terminating AED therapy in IGE or S/CLRE. In addition, attention should be paid to seizure pattern in IGE and symptomatic signs in LRE.
研究特发性全身性癫痫（IGE）和症状性/隐源性局灶性相关性癫痫（S/CLRE）中与停用抗癫痫药物（AEDs）相关的因素。方法：对于IGE研究，将71例能够停用AED的患者（IGE停药组）与71例继续进行AED治疗的患者（IGE继续治疗组）以及20例停用AED后癫痫复发的患者（IGE复发组）进行比较。对于S/CLRE，将90例能够停用AED的患者（S/CLRE停药组）与90例继续使用AED的患者（S/CLRE继续治疗组）以及76例能够停用AED的伴有中央颞区棘波的良性儿童癫痫患者（BECTS停药组）进行比较。
与IGE继续治疗组相比，IGE停药组癫痫发作倾向较弱，对AEDs反应较好，癫痫样放电抑制更频繁，全身性强直-阵挛发作（GTCs）频率较低。与IGE复发组相比，IGE停药组癫痫样放电抑制更频繁。与S/CLRE继续治疗组相比，S/CLRE停药组癫痫发作倾向较弱，对AEDs反应较好，癫痫样放电抑制更频繁，症状性体征较少。值得注意的是，癫痫发作起始年龄在IGE和S/CLRE中均不是停用AED的关键因素。尽管S/CLRE停药组比BECTS停药组症状性体征更频繁，癫痫发作起始年龄更大，癫痫样放电抑制更少，但两组在癫痫发作倾向和对AEDs的反应方面没有差异。
在预测IGE或S/CLRE中终止AED治疗的可能性时，应考虑癫痫发作倾向、癫痫样放电和对AEDs的反应。此外，应关注IGE中的癫痫发作模式和LRE中的症状性体征。
