Ring H, Zia A, Bateman N, Williams E, Lindeman S, Himlok K
Developmental Psychiatry Section, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge CB2 8AH, UK.
Seizure. 2009 May;18(4):264-8. doi: 10.1016/j.seizure.2008.10.009. Epub 2008 Nov 28.
Epilepsy in those with learning disability (LD) is currently managed by various health agencies with no obvious criteria for selecting particular care pathways and limited evidence-based descriptions of optimal treatment. The aim of this study was to examine relationships between management strategies and clinical outcomes in a community-based cohort of individuals with epilepsy and LD. The results may inform epilepsy management directly and contribute to an evidence base to support development of formal clinical trials. An attempt was made to recruit all individuals with epilepsy and LD known to community LD health services in one geographic area. However, those with profound LD were under-represented in the final sample. Information relating to the epilepsy, the severity of the LD, comorbidities and epilepsy management were obtained retrospectively both from the clinical notes and from interviews with carers and clinicians. We recruited 183 individuals of whom 33% had no reported seizures in the previous three months whilst 12% recorded more than 20 seizures per month. 73 individuals were receiving monotherapy, 66 were treated with two AEDs and 42 were prescribed three or more AEDs at the time of the study. In those taking monotherapy, there was no difference in the mean monthly seizure frequency between groups taking different AEDs. Similarly, for those prescribed two AEDS, no particular combination was associated with significantly lower seizure frequency. One third of the sample was receiving epilepsy management from hospital neurology services but no criteria determining choice of treatment pathway were identified. The findings suggest that more research needs to be carried out to identify both optimal care pathways and AED strategies.
目前，学习障碍（LD）患者的癫痫由各种卫生机构管理，在选择特定护理途径方面没有明确标准，且关于最佳治疗的循证描述有限。本研究的目的是在一个以社区为基础的癫痫和LD患者队列中，研究管理策略与临床结局之间的关系。研究结果可能直接为癫痫管理提供信息，并有助于建立一个循证基础，以支持正式临床试验的开展。研究人员试图招募某一地理区域内社区LD卫生服务机构已知的所有癫痫和LD患者。然而，严重LD患者在最终样本中的占比不足。通过回顾临床记录以及与护理人员和临床医生的访谈，获取了有关癫痫、LD严重程度、合并症和癫痫管理的信息。我们招募了183名患者，其中33%在过去三个月内未报告癫痫发作，而12%每月记录的癫痫发作超过20次。在研究时，73名患者接受单一疗法，66名接受两种抗癫痫药物（AED）治疗，42名服用三种或更多AED。在接受单一疗法的患者中，服用不同AED的组间平均每月癫痫发作频率没有差异。同样，对于那些服用两种AED的患者，没有哪种特定组合与显著更低的癫痫发作频率相关。三分之一的样本由医院神经科服务进行癫痫管理，但未发现决定治疗途径选择的标准。研究结果表明，需要开展更多研究来确定最佳护理途径和AED策略。
