Ramos-Lizana J, Aguirre-Rodríguez J, Aguilera-López P, Cassinello-García E
Paediatric Neurology Unit, Department of Paediatrics, Torrecárdenas Hospital, Almería, Spain.
Dev Med Child Neurol. 2009 Jan;51(1):68-73. doi: 10.1111/j.1469-8749.2008.03124.x. Epub 2008 Nov 20.
The aim of this study was to assess recurrence risk after a first remote symptomatic unprovoked seizure in childhood. All consecutive patients younger than 14 years with a first remote symptomatic unprovoked seizure who were seen at our hospital between 1994 and 2006 were included in the study and prospectively followed. Only two patients received antiepileptic treatment. Sixty-three children were included, with 35 males and 28 females. Mean age at first seizure was 4 years (SD 3y 5mo). Kaplan-Meier estimate of recurrence risk was 59% (95% confidence interval [CI] 47-71), 76% (95% CI 65-87), 85% (95% CI 76-94), and 87% (95% CI 78-96) at 6, 12, 18, and 24 months respectively. A total of 55 children out of 63 were affected by a static encephalopathy of pre- or perinatal origin. In this subgroup, recurrence risk at 12 and 24 months was 79% (95% CI 68-90) and 89% (95% CI 80-98). Univariable analysis using the Cox proportional hazards model showed that presence of global developmental delay/intellectual disability and Todd's paresis were associated with a significant increase in recurrence risk. In multivariable analysis, only Todd's paresis was significantly associated. Recurrence risk after a first remote symptomatic unprovoked seizure in childhood is much higher than what some previous studies suggests.
本研究的目的是评估儿童首次出现症状性不明原因的远隔性癫痫发作后的复发风险。1994年至2006年间在我院就诊的所有14岁以下首次出现症状性不明原因的远隔性癫痫发作的连续患者均纳入本研究并进行前瞻性随访。只有两名患者接受了抗癫痫治疗。纳入63名儿童，其中35名男性，28名女性。首次癫痫发作的平均年龄为4岁（标准差3岁5个月）。Kaplan-Meier法估计的复发风险在6个月、12个月、18个月和24个月时分别为59%（95%置信区间[CI]47 - 71）、76%（95%CI 65 - 87）、85%（95%CI 76 - 94）和87%（95%CI 78 - 96）。63名儿童中有55名受产前或围产期起源的静态脑病影响。在这个亚组中，12个月和24个月时的复发风险分别为79%（95%CI 68 - 90）和89%（95%CI 80 - 98）。使用Cox比例风险模型进行的单变量分析显示，存在全面发育迟缓/智力残疾和托德麻痹与复发风险显著增加相关。在多变量分析中，只有托德麻痹与复发风险显著相关。儿童首次出现症状性不明原因的远隔性癫痫发作后的复发风险远高于一些先前研究所表明的风险。
