Departments of Public Health and Child Neurology, 20014 Turku University, Turku, Finland.
Brain. 2012 Jul;135(Pt 7):2256-62. doi: 10.1093/brain/aws062. Epub 2012 Apr 11.
Given the grave morbidity and mortality of drug-resistant epilepsy, it is of great clinical interest to determine how often prior proven drug-resistant epilepsy is reversible without surgery and whether remission can be predicted by clinical features in children with incident drug-resistant epilepsy. We determined the likelihood of 1-, 2- and 5-year seizure remission and terminal 5-year seizure remission after the first adequate drug regimen in a population-based cohort of 102 medically treated patients with incident, i.e. first-ever occurrence of drug-resistant epilepsy, as defined by the International League against Epilepsy. Among the 102 patients, 98 had focal seizures (68 symptomatic and 30 idiopathic/cryptogenic), one had generalized convulsive seizures and three had unclassified seizures. At the end of the 40.5-year median follow-up from the onset of adequate medication before the age of 16 years, 84 (82%) of 102 patients with incident drug-resistant epilepsy eventually entered one or more 1-year remissions, 81 (79%) one or more 2-year remissions, 70 (69%) one or more 5-year remissions and 52 (51%) of 102 5-year terminal remissions. In contrast, 18 (18%) of 102 patients with incident drug-resistant epilepsy never entered any 1-year remission, 21 (21%) 2-year remission, 32 (31%) 5-year remission and 50 (49%) of 102 any 5-year terminal remission. On multivariate analysis of clinical features, in every remission category, idiopathic or cryptogenic aetiology was the only significant predictor of entering remission. Incident drug-resistant epilepsy is eventually reversible in 49-79% of patients with mostly focal epilepsy, resulting in long-term remission of variable duration. Idiopathic or cryptogenic aetiology is a clinical predictor of reversible drug-resistant epilepsy.
鉴于耐药性癫痫的严重发病率和死亡率，确定先前已确诊的耐药性癫痫在多大程度上可以不经手术逆转，以及在新诊断为耐药性癫痫的儿童中，临床特征是否可以预测缓解，这具有重要的临床意义。我们在一个基于人群的队列中确定了 102 名接受药物治疗的新发耐药性癫痫患者（定义为国际抗癫痫联盟）首次出现耐药性癫痫发作，即首次出现耐药性癫痫发作），在第一个适当的药物治疗方案后 1 年、2 年和 5 年的癫痫缓解率以及终端 5 年的癫痫缓解率。在 102 名患者中，98 名有局灶性发作（68 名症状性和 30 名特发性/隐源性），1 名有全面性强直阵挛发作，3 名发作类型未分类。在 16 岁之前开始适当药物治疗后 40.5 年的中位随访期结束时，102 名新发耐药性癫痫患者中，84 名（82%）最终进入 1 年缓解期 1 次或多次，81 名（79%）进入 2 年缓解期 1 次或多次，70 名（69%）进入 5 年缓解期 1 次或多次，52 名（51%）进入 102 名患者中的 5 年缓解期。相比之下，102 名新发耐药性癫痫患者中，有 18 名（18%）从未进入任何 1 年缓解期，21 名（21%）进入 2 年缓解期，32 名（31%）进入 5 年缓解期，50 名（49%）进入 5 年缓解期。在对临床特征的多变量分析中，在每个缓解类别中，特发性或隐源性病因是进入缓解的唯一显著预测因素。大部分局灶性癫痫患者的新发耐药性癫痫最终是可以逆转的，导致不同持续时间的长期缓解。特发性或隐源性病因是耐药性癫痫可逆转的临床预测因素。
