C. Besta Foundation Neurological Institute, Epilepsy Center, Milan, Italy.
Epilepsia. 2012 Apr;53(4):733-40. doi: 10.1111/j.1528-1167.2012.03416.x. Epub 2012 Feb 23.
To classify the grade of antiepileptic drug (AED) resistance in a cohort of patients with focal epilepsies, to recognize the risk factors for AED resistance, and to estimate the helpfulness of "new-generation" AEDs.
We included 1,155 adults with focal epilepsies who were observed consecutively after 1990 and followed regularly at two epilepsy centers. We systematically collected the clinical, diagnostic, and therapeutic data using a custom-written database. We classified the patients as seizure-free or AED resistant according to the International League Against Epilepsy (ILAE) criteria, and we evaluated the risk factors associated with AED resistance using logistic regression analysis. We further grouped AED-resistant patients in different grades (I, II, and III) according to the number of AEDs already tried as proposed by Perucca.
AED resistance occurred in 57.8% of the 729 patients with symptomatic focal epilepsies and was positively associated with electroencephalography (EEG) abnormalities, seizure type, and the presence of mesial temporal sclerosis. Among 426 patients without detectable causes, the percentage of AED resistance was significantly lower (39.2%) and correlated with EEG abnormalities and psychiatric symptoms. Among AED-resistant patients, the majority (64.6%) had tried three or more AEDs, which fit the more severe grade III proposed by Perucca. Among seizure-free patients, more than one-half (57%) needed to try two or more AEDs before reaching seizure control (14.9% needed three or more AEDs). Furthermore, among seizure-free patients who could be previously classified as resistant to two or more AEDs, 52.2% reached seizure freedom while receiving treatment with "new generation" AEDs.
The ILAE classification of AED resistance, as well the graded classification proposed by Perucca, was easily exploitable in our patients, although these classifications systems appear to have a limited value in predicting seizure outcome. Actually, a small but not negligible percentage of patients reached seizure freedom after trying several AEDs (including "new" AEDs), suggesting repeated trials may be necessary for seizure control.
对 1990 年后连续观察的、在两个癫痫中心定期随访的局灶性癫痫患者队列进行抗癫痫药物（AED）耐药分级，识别 AED 耐药的危险因素，并评估“新一代”AED 的疗效。
我们纳入了 1155 例局灶性癫痫患者，采用定制数据库系统地收集了临床、诊断和治疗数据。我们根据国际抗癫痫联盟（ILAE）标准将患者分为无发作或 AED 耐药，并使用 logistic 回归分析评估了与 AED 耐药相关的危险因素。我们根据 Perucca 提出的标准，将 AED 耐药患者进一步分为不同等级（I、II 和 III）。
729 例症状性局灶性癫痫患者中，AED 耐药发生率为 57.8%，与脑电图（EEG）异常、发作类型和存在内侧颞叶硬化有关。在 426 例未发现病因的患者中，AED 耐药率明显较低（39.2%），与 EEG 异常和精神症状有关。在 AED 耐药患者中，大多数（64.6%）已尝试了 3 种或更多 AED，符合 Perucca 提出的更严重的 III 级。在无发作患者中，超过一半（57%）需要尝试 2 种或更多 AED 才能达到控制发作的效果（14.9%需要 3 种或更多 AED）。此外，在先前被分类为对 2 种或更多 AED 耐药的无发作患者中，52.2%在接受“新一代”AED 治疗时达到无发作。
我们的患者很容易应用 ILAE 分级和 Perucca 提出的分级来分类 AED 耐药，但这些分级系统似乎在预测发作结果方面的价值有限。实际上，有一小部分但并非微不足道的患者在尝试多种 AED（包括“新型”AED）后达到无发作，这表明可能需要反复尝试以控制发作。
