Huber Bernd, Hauser Ines, Horstmann Verena, Jokeit Gabi, Liem Sylvia, Meinert Thomas, Robertson Enrique, Schorlemmer Heide, Wagner Wolfgang, Seidel Michael
Ebenezerweg 18, 33617 Bielefeld, Germany.
Seizure. 2005 Sep;14(6):381-6. doi: 10.1016/j.seizure.2005.05.005.
Epilepsy is a frequent condition in persons with intellectual disability and is more often difficult to treat than in the average population. Seizure freedom is the primary therapeutic goal which has important implications for the patient's quality of life. The aim of this study was to find out which antiepileptic therapy regimens (monotherapy or combination therapy) are effective in achieving this goal in intellectually disabled epilepsy patients. We were especially interested in the impact of the new antiepileptic drugs (AEDs) which were introduced during the past decade.
We investigated retrospectively the antiepileptic regimens on which the resident patients of a large epilepsy centre (as a rule with additional intellectual disabilities of different degrees) were seizure free in 2002. Information on antiepileptic medication and seizure frequency was taken out of the individual case documentation. It was also determined whether seizure free patients had already been seizure free in 1992.
Two hundred and forty out of 675 patients (35,6%) with epilepsy were seizure free. The proportion of seizure freedom was 43,7% in patients with borderline intelligence, 39,2% in mild, 33,2% in moderate, 31,9% in severe, and 21,9% in profound intellectual disability. One hundred and twenty-two (50,8%) seizure free patients were on monotherapy; 53 of them were on CBZ (PB: 34, VPA: 25, PHT: 7, LTG: 3). Ninety-three patients (38,7%) were on duotherapies, CBZ/PB (27 patients), PB/PHT (17), and LTG/VPA (14) being the commonest. Of 18 (7,5%) triple therapies, LTG/PB/VPA (4 patients) was the commonest. Taken together, the five most frequent therapeutic regimens were CBZ monotherapy, PB monotherapy, CBZ/PB, VPA monotherapy and PB/PHT (a clear preponderance of classic AEDs). A distinction was made between "old seizure free" (seizure free already in 1992) and "new seizure free" (in 1992 still seizures) patients. In the 132 old seizure free patients the classic AEDs prevailed again, monotherapies with CBZ, PB and VPA being the most frequent regimens. In comparison, in the 78 new seizure free patients the novel combination LTG/VPA was the third most frequent, after the classic regimens CBZ/PB and CBZ; PB monotherapies were rare.
In a majority of intellectually disabled patients with epilepsy (including those who became seizure free since 1992), complete seizure control has been achieved by monotherapy or duotherapy with classic AEDs. Of the new AEDs LTG in combination with VPA appears to be an important innovation.
癫痫在智力残疾患者中很常见，且相较于普通人群往往更难治疗。无癫痫发作是主要治疗目标，这对患者的生活质量有重要影响。本研究旨在找出哪种抗癫痫治疗方案（单药治疗或联合治疗）对实现智力残疾癫痫患者的这一目标有效。我们特别关注过去十年引入的新型抗癫痫药物（AEDs）的影响。
我们回顾性调查了一家大型癫痫中心（通常伴有不同程度的额外智力残疾）住院患者在2002年无癫痫发作所采用的抗癫痫治疗方案。从个体病例记录中获取抗癫痫药物治疗及癫痫发作频率的信息。还确定了无癫痫发作的患者在1992年是否已经无癫痫发作。
675例癫痫患者中有240例（35.6%）无癫痫发作。边缘智力患者的无癫痫发作比例为43.7%，轻度智力残疾患者为39.2%，中度为33.2%，重度为31.9%，极重度为21.9%。122例（50.8%）无癫痫发作患者采用单药治疗；其中53例使用卡马西平（苯巴比妥：34例，丙戊酸：25例，苯妥英：7例，拉莫三嗪：3例）。93例患者（38.7%）采用联合治疗，最常见的是卡马西平/苯巴比妥（27例患者）、苯巴比妥/苯妥英（17例）和拉莫三嗪/丙戊酸（14例）。在18例（7.5%）三联治疗中，最常见的是拉莫三嗪/苯巴比妥/丙戊酸（4例患者）。总体而言，五种最常见的治疗方案是卡马西平单药治疗、苯巴比妥单药治疗、卡马西平/苯巴比妥、丙戊酸单药治疗和苯巴比妥/苯妥英（经典AEDs明显占优势）。区分了“旧的无癫痫发作”（1992年就已无癫痫发作）和“新的无癫痫发作”（1992年仍有癫痫发作）患者。在132例旧的无癫痫发作患者中，经典AEDs再次占主导，卡马西平、苯巴比妥和丙戊酸单药治疗是最常见的方案。相比之下，在78例新的无癫痫发作患者中，新型联合用药拉莫三嗪/丙戊酸是第三常见的，仅次于经典方案卡马西平/苯巴比妥和卡马西平；苯巴比妥单药治疗很少见。
在大多数智力残疾癫痫患者中（包括自1992年以来无癫痫发作的患者），通过经典AEDs的单药治疗或联合治疗实现了完全癫痫控制。在新型AEDs中，拉莫三嗪与丙戊酸联合似乎是一项重要创新。
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