Kong Sing Teang, Ho Choon Siang, Ho Paul C, Lim Shih-Hui
Department of Pharmacy, National University of Singapore, Singapore.
Department of Pharmacy, National University of Singapore, Singapore.
Epilepsy Res. 2014 Sep;108(7):1253-62. doi: 10.1016/j.eplepsyres.2014.05.005. Epub 2014 May 13.
To determine the proportion of population of adult people with epilepsy (PWE) in Singapore, who suffer from drug resistant epilepsy (DRE).
All adult PWE who had attended the neurology specialist clinic of a tertiary referral hospital in Singapore were profiled for drug responses according to the definition for DRE as specified by the International League against Epilepsy (ILAE) 2010 consensus. This is a retrospective cohort study. Data collected included demographics, characteristics of seizure and epilepsy, blood biochemistry levels, electroencephalogram and brain imaging findings, and medication histories. The types and dosages of antiepileptic drugs (AEDs) used were retrieved from case notes and checked against pharmacy records. Each patient was counselled upon the diagnosis of epilepsy and taught to maintain a seizure diary. The dates and number of seizures were retrieved from these diaries at each visit. Treatment-related adverse effects were routinely assessed and hence, patients were assumed to not have treatment-related adverse effects when no relevant documentation was encountered.
The prevalence rate of DRE in this clinic was 21.5%, while 40.9% of PWE were drug responsive/seizure free at the point prevalence day (n=557). From multivariate analysis, patients with structural-metabolic aetiology [odds ratio (OR) 1.78, 95% confidence interval (CI) 1.003-3.148], mental retardation [OR 2.51, 95% CI 1.073-5.863], psychiatric illnesses [OR 3.349, 95% CI 1.181-9.501] and pre-treatment seizure frequency of more than once monthly [OR 2.775, 95% CI 1.190-6.469] were found to be more likely to have DRE (p≤0.05). Although the influence of Indian ethnicity on the risk of DRE was only found in the univariate analysis, it warrants investigation in a larger cohort.
The findings may aid policy makers in designing treatment guidelines and allocating resources around PWE, with careful considerations that at any given time, 1 in 5 PWE have DRE.
确定新加坡成年癫痫患者（PWE）中耐药性癫痫（DRE）患者的比例。
根据国际抗癫痫联盟（ILAE）2010年共识中规定的DRE定义，对所有曾就诊于新加坡一家三级转诊医院神经科专科门诊的成年PWE进行药物反应分析。这是一项回顾性队列研究。收集的数据包括人口统计学信息、癫痫发作和癫痫的特征、血液生化水平、脑电图和脑成像结果以及用药史。使用的抗癫痫药物（AEDs）的类型和剂量从病例记录中获取，并与药房记录进行核对。每位患者在癫痫诊断后接受咨询，并被教导记录癫痫发作日记。每次就诊时从这些日记中获取癫痫发作的日期和次数。常规评估与治疗相关的不良反应，因此，当未遇到相关记录时，假定患者没有与治疗相关的不良反应。
该诊所中DRE的患病率为21.5%，而在现患率日，40.9%的PWE药物反应良好/无癫痫发作（n = 557）。多因素分析显示，结构性代谢病因患者[比值比（OR）1.78，95%置信区间（CI）1.003 - 3.148]、智力低下患者[OR 2.51，95% CI 1.073 - 5.863]、精神疾病患者[OR 3.349，95% CI 1.181 - 9.501]以及治疗前每月癫痫发作频率超过一次的患者[OR 2.775，95% CI 1.190 - 6.469]更有可能患有DRE（p≤0.05）。虽然仅在单因素分析中发现印度族裔对DRE风险有影响，但值得在更大的队列中进行研究。
这些发现可能有助于政策制定者制定治疗指南并围绕PWE分配资源，同时要谨慎考虑到在任何给定时间，每5名PWE中就有1名患有DRE。
