Epilepsy Center, Children's Memorial Hospital, Northwestern University, Chicago, IL, USA.
Ann Neurol. 2011 Oct;70(4):566-73. doi: 10.1002/ana.22461. Epub 2011 Jun 27.
Determine the probability of attaining complete remission in children with nonsyndromic epilepsy (NSE) over the course of ≥10 years from initial diagnosis; identify early predictors of complete remission; and assess the risk of relapse after achieving complete remission.
In a prospective community-based cohort, complete remission was defined as 5 years seizure-free and medication-free. Any subsequent seizure for any reason was a relapse. Univariate and bivariate analyses were conducted with standard methods including the Kaplan-Meier approach. Proportional hazards modeling was used for multivariable analysis.
Of 613 cohort members, 347 had NSEs, of whom 294 (85%) were followed ≥10 years (maximum = 17.9). A total of 170 in 294 (58%) achieved complete remission, 10 of whom (6%) relapsed. Seizure outcome at 2 years (remission, pharmacoresistant, unclear) (p < 0.0001) and underlying cause (p < 0.0001) distinguished groups with complete remission ranging from ~20% to ~75%. Older age at onset was independently associated with a poorer chance of complete remission. Relapses occurred up to 7.5 years after attaining complete remission and were marginally associated with underlying cause (p = 0.06).
Complete remission occurs in over one-half of young people with NSE and generally persists. Meaningful but imperfect predication is possible based on underlying cause and early seizure control. The finding of age effects may play a role in meaningful identification of phenotypes, which could become fruitful targets for genetic and imaging investigations in these otherwise poorly differentiated epilepsies.
确定从初诊起≥10 年内，非综合征性癫痫（NSE）患儿达到完全缓解的概率；确定完全缓解的早期预测因素；并评估达到完全缓解后复发的风险。
在一项前瞻性的社区队列研究中，完全缓解定义为 5 年无发作且无药物治疗。任何因任何原因导致的后续发作均为复发。采用标准方法进行单变量和双变量分析，包括 Kaplan-Meier 方法。采用比例风险模型进行多变量分析。
在 613 名队列成员中，347 人患有 NSE，其中 294 人（85%）随访时间≥10 年（最长为 17.9 年）。294 人中共有 170 人（58%）达到完全缓解，其中 10 人（6%）复发。2 年时的癫痫发作结局（缓解、耐药、不明）（p < 0.0001）和潜在病因（p < 0.0001）区分了完全缓解率在 20%至 75%之间的不同组别。发病年龄较大与完全缓解的可能性降低独立相关。缓解后 7.5 年内发生复发，与潜在病因有一定关联（p = 0.06）。
超过一半的 NSE 青少年患者达到完全缓解，且通常持续缓解。基于潜在病因和早期癫痫控制，可进行有意义但不完全的预测。年龄效应的发现可能在有意义地确定表型方面发挥作用，这可能成为这些分类不良的癫痫中进行遗传和影像学研究的富有成效的目标。
