Kishore D, Misra S
Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi -221 005, India.
J Assoc Physicians India. 2007 Jun;55:419-24.
To evaluate the effect of a short course of oral prednisolone on disappearance of lesion and seizure recurrence in newly diagnosed patients with single small enhancing CT lesion.
In this open-label, randomized, prospective follow-up study, 100 patients of new-onset seizures and a cysticercus granuloma presenting as single enhancing computed tomography detected lesion were randomly divided in two groups to receive either antiepileptic monotherapy (Group A) or antiepileptic drugs with oral prednisolone in a dose of 1 mg/kg body weight for 7 days and tapering off dose in next 3 days (Group B). Repeat CT scan was performed on 8th-12th week to know radiological state of lesion. The patients were followed up for 1 year for seizure recurrence.
The majority of patients were in second decade. Male: female ratio 1.56:1. Mean number of seizure episodes was 4.33 +/- 3.50 in group A and 4.23 +/- 3.97 in group B. Partial seizure were the most common presentation (85%). 72% patients presented with single seizure or seizure in cluster. Solitary ring lesion was the commonest (69%) CT finding, most of them were located in parietal lobe (52%). Follow up CT scan showed complete resolution of lesion in 60.86% of total [group A (n = 47), 32 patients, 68.08%; group B (n = 45), 24 patients, 53.33%]. Significant difference in group A and B regarding lesion resolution was observed (chi2 = 5.926, d.f. = 1) p < 0.05. Clinical follow up showed seizure recurrence in group A - 5 patients (10.63%), in group B - 12 patients (26.66%). Statistically significant higher number of seizure recurrences were noted in group B as compared to group A (chi2 = 3.93, d.f. = 1) p < 0.05.
Short-term oral prednisolone along with antiepileptic drugs helps in rapid resolution of single small enhancing lesions in patient with newly diagnosed seizure disorder with good clinical outcome.
评估短期口服泼尼松龙对新诊断的单个小强化CT病灶患者病灶消失及癫痫复发的影响。
在这项开放标签、随机、前瞻性随访研究中，将100例新发癫痫且CT检查发现单个强化病灶的囊尾蚴肉芽肿患者随机分为两组，分别接受抗癫痫单药治疗（A组）或抗癫痫药物联合口服泼尼松龙（剂量为1mg/kg体重，持续7天，接下来3天逐渐减量）治疗（B组）。在第8至12周进行重复CT扫描以了解病灶的影像学状态。对患者进行为期1年的癫痫复发随访。
大多数患者处于第二个十年。男女比例为1.56:1。A组平均癫痫发作次数为4.33±3.50次，B组为4.23±3.97次。部分性发作是最常见的表现形式（85%）。72%的患者表现为单次发作或成簇发作。孤立环形病灶是最常见的CT表现（69%），其中大多数位于顶叶（52%）。随访CT扫描显示，全部患者中有60.86%的病灶完全消退[A组（n = 47），32例患者，68.08%；B组（n = 45），24例患者，53.33%]。A组和B组在病灶消退方面存在显著差异（χ2 = 5.926，自由度 = 1），p < 0.05。临床随访显示，A组有5例患者（10.63%）癫痫复发，B组有12例患者（26.66%）癫痫复发。与A组相比，B组癫痫复发的统计学显著更高（χ2 = 3.93，自由度 = 1），p < 0.05。
短期口服泼尼松龙联合抗癫痫药物有助于新诊断癫痫患者中单个小强化病灶的快速消退，临床效果良好。
