Blume Warren T
Department of Clinical Neurological Sciences, London Health Sciences Centre London, Ontario, Canada.
Epilepsia. 2006;47 Suppl 1:71-8. doi: 10.1111/j.1528-1167.2006.00665.x.
Prognosis for seizure control and cognitive development varies considerably among syndromes. Several factors may interact to influence outcome of an epilepsy including a causative etiology, ictal and interictal discharges, seizure-related trauma or systemic perturbations, and antiepileptic drug (AED) effects. Clinical evidence convincingly supporting Gowers' hypothesis that seizures beget seizures is lacking. Short-term seizure suppression by early treatment does not appear to influence long-term prognosis. Malignant epilepsy syndromes usually begin in infancy or childhood, have a high seizure frequency, resist the initial AED, and are often associated with progressive cognitive dysfunction. Prompt management of some severe epilepsy syndromes may lessen cognitive decline. However, aggressive AEDs therapy must be balanced against the potential for cognitive side effects, particularly if multiple AEDs are used. Several experimental paradigms closely parallel human TLE as both have an initial precipitating injury (IPI), a latent period, then recurrent spontaneous seizures. In humans, an IPI is any medical event with neurological implications. Although transition from a latent period to a seizure disorder certainly constitutes "progression" of the disorder, convincing clinical evidence of subsequent worsening has not emerged. Substantial clinical and experimental evidence indicates some cognitive regression and focal atrophy with time for TLE and other intractable syndromes. However, seizure frequency and severity, established early in the disorder, appear stable in most patients, and even regress in benign syndromes. Factors mitigating or extinguishing epilepsies need to be further sought.
癫痫发作控制和认知发展的预后在不同综合征之间差异很大。几个因素可能相互作用以影响癫痫的预后，包括病因、发作期和发作间期放电、与癫痫发作相关的创伤或全身紊乱以及抗癫痫药物（AED）的作用。目前缺乏令人信服的临床证据支持高尔斯的癫痫引发癫痫的假说。早期治疗对癫痫发作的短期抑制似乎并不影响长期预后。恶性癫痫综合征通常始于婴儿期或儿童期，癫痫发作频率高，对初始抗癫痫药物耐药，且常与进行性认知功能障碍相关。对一些严重癫痫综合征的及时处理可能会减轻认知功能下降。然而，积极的抗癫痫药物治疗必须与认知副作用的可能性相平衡，特别是如果使用多种抗癫痫药物时。几种实验范式与人类颞叶癫痫密切相似，因为两者都有初始促发损伤（IPI）、潜伏期，然后是反复自发癫痫发作。在人类中，IPI是任何具有神经学意义的医学事件。虽然从潜伏期转变为癫痫障碍肯定构成了该疾病的“进展”，但后续病情恶化的令人信服的临床证据尚未出现。大量临床和实验证据表明，随着时间的推移，颞叶癫痫和其他难治性综合征会出现一些认知衰退和局灶性萎缩。然而，在疾病早期确定的癫痫发作频率和严重程度在大多数患者中似乎是稳定的，甚至在良性综合征中会有所缓解。需要进一步寻找减轻或消除癫痫的因素。
