Zeng Tian-fang, Li Yao-hua, An Dong-mei, Chen Lei, Lei Ding, Zhang Bei, Li Jin-mei, Zhou Dong
Department of Neurology, West China Hospital of Sichuan University; Department of Neurology, Chengdu second people's hospital.
Department of Neurology, West China Hospital of Sichuan University.
Epilepsy Res. 2014 Dec;108(10):1904-11. doi: 10.1016/j.eplepsyres.2014.09.034. Epub 2014 Oct 13.
This study aimed to evaluate the effectiveness of levetiracetam (LEV) use for seizure control in patients who had undergone resective surgery for intractable epilepsy in routine clinical practice.
This was a prospective, observational study. Refractory epilepsy patients who underwent epilepsy surgery from January 2008 to December 2011 in the Department of Neurosurgery, West China Hospital were prospectively analyzed. Patients were divided into two groups according to antiepileptic drug (AED) treatment used immediately after epilepsy surgery (group A: therapy with LEV; group B: therapy without LEV). AED regimens were compared with regard to seizure-outcome for a period of more than 2 years. The International League Against Epilepsy (ILAE) classification was used to categorize seizure outcome.
A total of 319 patients (184 male and 135 female patients; mean age 28.2±13.4 years) were studied. The mean postoperative follow-up period was 3.9±1.2 years. The two groups showed was no significant difference in preoperative baseline data. At the 6-month follow-up, the proportion of patients with seizure freedom was significantly higher in group A than in group B (78.8% vs. 67.5%, p=0.03). Seizure outcomes after 2 years were assessed using the ILAE classification. The proportion of patients under ILAE seizure-outcome classification I (seizure freedom) was significantly higher in group A than in group B (74.3% vs. 60.7%, p=0.01). Seizure recurrence rates at the final assessment, after planned reduction or withdrawal, were 26.3% for group A and 40.6% for group B (p=0.04).
AED strategy after resective surgery may be a potentially modifiable prognostic indicator influencing seizure outcome in patients with intractable epilepsy. Compared to other AEDs, LEV appears to be more effective in controlling postoperative seizures in our long-term follow-up, and the advantage can be seen in early stage after surgery.
本研究旨在评估在常规临床实践中，左乙拉西坦（LEV）用于控制难治性癫痫患者切除术后癫痫发作的有效性。
这是一项前瞻性观察性研究。对2008年1月至2011年12月在华西医院神经外科接受癫痫手术的难治性癫痫患者进行前瞻性分析。根据癫痫手术后立即使用的抗癫痫药物（AED）治疗将患者分为两组（A组：使用LEV治疗；B组：不使用LEV治疗）。比较AED治疗方案超过2年的癫痫发作结果。采用国际抗癫痫联盟（ILAE）分类对癫痫发作结果进行分类。
共研究了319例患者（男性184例，女性135例；平均年龄28.2±13.4岁）。术后平均随访时间为3.9±1.2年。两组术前基线数据无显著差异。在6个月随访时，A组无癫痫发作患者的比例显著高于B组（78.8%对67.5%，p = 0.03）。使用ILAE分类评估2年后的癫痫发作结果。A组中ILAE癫痫发作结果分类为I级（无癫痫发作）的患者比例显著高于B组（74.3%对60.7%，p = 0.01）。在计划减量或停药后的最终评估中，A组癫痫复发率为26.3%，B组为40.6%（p = 0.04）。
切除术后的AED策略可能是影响难治性癫痫患者癫痫发作结果的一个潜在可改变的预后指标。与其他AED相比，在我们的长期随访中，LEV似乎在控制术后癫痫发作方面更有效，且在术后早期即可显现优势。
