Division of Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Epilepsia. 2012 Sep;53(9):1563-9. doi: 10.1111/j.1528-1167.2012.03562.x. Epub 2012 Jun 27.
To determine the prevalence and identify predictors of medical intractability in children presenting with epilepsy before 36 months of age, and to assess the effect of medical intractability on long-term mortality and intellectual function.
Children with newly diagnosed epilepsy before 36 months between 1980 and 2009 while resident in Olmsted County, MN, were identified. Medical records were reviewed to collect epilepsy-specific variables and long-term outcome data. Medically intractable epilepsy was defined as either (1) seizure frequency greater than every 6 months at final follow-up and failure of two or more antiepileptic drugs for lack of efficacy, or (2) having undergone epilepsy surgery after failure to respond to two or more antiepileptic drugs.
One hundred twenty-seven children with new-onset epilepsy were identified and followed for a median of 78 months. Medically intractable seizures occurred in 35%, and significant predictors on multivariate analysis were age ≤12 months at diagnosis (odds ratio [OR] 6.76, 95% confidence interval [CI] 2.00, 22.84, p = 0.002), developmental delay at initial diagnosis of epilepsy (OR 20.03, 95% CI 3.49, 114.83, p = 0.0008), neuroimaging abnormality (OR 6.48, 95% CI 1.96, 21.40, p = 0.002), and focal slowing on initial EEG (OR 5.33, 95% CI 1.14, 24.88, p = 0.03). Medical intractability occurred early in the course in most children, being seen in 61% by 1 year, and 93% by 5 years after initial diagnosis. Mortality was higher (20% vs. 0%, p < 0.001) and intellectual outcome poorer (p < 0.001) if epilepsy was medically intractable.
One third of children presenting with epilepsy before 36 months will be medically intractable, and significant predictors are identified. Medically intractable epilepsy is associated with increased mortality risk and significant intellectual disability.
确定在 36 个月之前出现癫痫的儿童中，医学难治性的发生率和识别预测因素，并评估医学难治性对长期死亡率和智力功能的影响。
1980 年至 2009 年间，在明尼苏达州奥姆斯特德县发现患有新诊断的 36 个月之前的癫痫的儿童。审查病历以收集癫痫特定变量和长期结局数据。医学难治性癫痫定义为：（1）在最终随访时，发作频率大于每 6 个月，并且由于缺乏疗效而两种或更多种抗癫痫药物失败；（2）在对两种或更多种抗癫痫药物无反应后进行癫痫手术。
确定了 127 名新发癫痫儿童，并随访中位数为 78 个月。有 35%的患儿出现医学难治性发作，多变量分析的显著预测因素为诊断时年龄≤12 个月（比值比[OR]6.76，95%置信区间[CI]2.00，22.84，p=0.002），癫痫初始诊断时发育迟缓（OR 20.03，95%CI 3.49，114.83，p=0.0008），神经影像学异常（OR 6.48，95%CI 1.96，21.40，p=0.002），以及初始 EEG 上出现局灶性慢波（OR 5.33，95%CI 1.14，24.88，p=0.03）。大多数患儿在病程早期就出现了难治性，1 年内有 61%的患儿，5 年内有 93%的患儿出现难治性。如果癫痫是医学难治性的，则死亡率更高（20%比 0%，p<0.001），智力结局更差（p<0.001）。
在 36 个月之前出现癫痫的儿童中，有三分之一会出现医学难治性，并且可以识别出显著的预测因素。医学难治性癫痫与死亡率增加和显著的智力残疾相关。
