Western Infirmary, Glasgow.
Neurology. 2012 May 15;78(20):1548-54. doi: 10.1212/WNL.0b013e3182563b19. Epub 2012 May 9.
To delineate the temporal patterns of outcome and to determine the probability of seizure freedom with successive antiepileptic drug regimens in newly diagnosed epilepsy.
Patients in whom epilepsy was diagnosed and the first antiepileptic drug prescribed between July 1, 1982, and April 1, 2006, were followed up until March 31, 2008. Outcomes were categorized into 4 patterns: (A) early and sustained seizure freedom; (B) delayed but sustained seizure freedom; (C) fluctuation between periods of seizure freedom and relapse; and (D) seizure freedom never attained. Probability of seizure freedom with successive drug regimens was compared. Seizure freedom was defined as no seizures for ≥1 year.
A total of 1,098 patients were included (median age 32 years, range 9-93). At the last clinic visit, 749 (68%) patients were seizure-free, 678 (62%) on monotherapy. Outcome pattern A was observed in 408 (37%), pattern B in 246 (22%), pattern C in 172 (16%), and pattern D in 272 (25%) patients. There was a higher probability of seizure freedom in patients receiving 1 compared to 2 drug regimens, and 2 compared to 3 regimens (p < 0.001). The difference was greater among patients with symptomatic or cryptogenic than with idiopathic epilepsy. Less than 2% of patients became seizure-free on subsequent regimens but a few did so on their sixth or seventh regimen.
Most patients with newly diagnosed epilepsy had a constant course which could usually be predicted early. The chance of seizure freedom declined with successive drug regimens, most markedly from the first to the third and among patients with localization-related epilepsies.
描绘新诊断癫痫患者的结局时间模式，并确定连续抗癫痫药物治疗方案的无癫痫发作概率。
对 1982 年 7 月 1 日至 2006 年 4 月 1 日期间诊断为癫痫并首次开具抗癫痫药物的患者进行随访，随访至 2008 年 3 月 31 日。结局分为 4 种模式：（A）早期且持续无癫痫发作；（B）延迟但持续无癫痫发作；（C）无癫痫发作和复发之间波动；（D）从未达到无癫痫发作。比较连续药物治疗方案的无癫痫发作概率。无癫痫发作定义为无发作≥1 年。
共纳入 1098 例患者（中位年龄 32 岁，范围 9-93 岁）。最后一次就诊时，749 例（68%）患者无癫痫发作，678 例（62%）接受单药治疗。观察到 A 模式 408 例（37%），B 模式 246 例（22%），C 模式 172 例（16%），D 模式 272 例（25%）。与接受 1 种药物治疗方案相比，接受 2 种药物治疗方案和 3 种药物治疗方案的患者无癫痫发作的概率更高（p<0.001）。在症状性或隐源性癫痫患者中，与特发性癫痫患者相比，差异更大。不到 2%的患者在后续治疗方案中无癫痫发作，但少数患者在第 6 或第 7 种治疗方案中无癫痫发作。
大多数新诊断的癫痫患者具有可早期预测的持续病程。随着连续药物治疗方案的增加，无癫痫发作的概率降低，从第 1 种到第 3 种药物治疗方案，以及在与定位相关的癫痫患者中，降低更为显著。
