Mohanraj R, Brodie M J
Epilepsy Unit, Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow, Scotland, UK.
Eur J Neurol. 2006 Mar;13(3):277-82. doi: 10.1111/j.1468-1331.2006.01215.x.
Diagnosing refractory epilepsy would facilitate referral for specialist pharmacological review and early consideration of epilepsy surgery. An outcomes study was undertaken in an unselected cohort of newly diagnosed patients to determine the number of antiepileptic drug (AED) regimens needed to be failed before the epilepsy could be designated as pharmacoresistant. Between July 1982 and May 2001, 780 adolescents and adults prescribed their first AED at the Western Infirmary in Glasgow, Scotland provided longitudinal data suitable for analysis. Overall, 504 (64.6%) patients became seizure free for at least 12 months. Of these, 462 (59.2%) remained in remission, while 42 (5.4%) relapsed and subsequently developed refractory epilepsy. The relapse rate peaked at 10.4% after 8 years of follow-up. The other 276 (35.4%) patients were uncontrolled from the outset. Prognosis appeared better in seniors (85% remission, P < 0.001) and adolescents (65% remission, P < 0.01) than in the remainder of the population (55% remission). Overall response rates with the first, second and third treatment schedules were 50.4, 10.7 and 2.7%, respectively, with only 0.8% patients responding optimally to further drug trials. Patients not tolerating at least one AED schedule did better than those failing because of lack of efficacy. These data suggest that suitable patients failing two AED regimens should be referred for epilepsy surgery. Those who do not attain long-term seizure freedom with the first three treatment schedules are likely to have refractory epilepsy.
诊断难治性癫痫有助于转介患者接受专科药物评估，并尽早考虑癫痫手术。一项针对未经筛选的新诊断患者队列进行的结局研究，旨在确定在癫痫被认定为药物抵抗之前需要失败的抗癫痫药物（AED）治疗方案数量。1982年7月至2001年5月期间，在苏格兰格拉斯哥西部医院首次开具AED的780名青少年和成人提供了适合分析的纵向数据。总体而言，504名（64.6%）患者至少12个月无癫痫发作。其中，462名（59.2%）仍处于缓解期，而42名（5.4%）复发并随后发展为难治性癫痫。随访8年后复发率最高达到10.4%。另外276名（35.4%）患者从一开始就未得到控制。老年人（缓解率85%，P<0.001）和青少年（缓解率65%，P<0.01）的预后似乎比其余人群（缓解率55%）更好。第一、第二和第三个治疗方案的总体有效率分别为50.4%、10.7%和2.7%，只有0.8%的患者对进一步的药物试验反应最佳。不耐受至少一种AED治疗方案的患者比因缺乏疗效而治疗失败的患者情况更好。这些数据表明，适合的患者在两种AED治疗方案失败后应转介接受癫痫手术。在前三个治疗方案中未实现长期无癫痫发作的患者很可能患有难治性癫痫。
