Department of Clinical and Experimental Epilepsy, NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK.
Department of Neurology, Homerton University Hospital, London, UK.
J Neurol Neurosurg Psychiatry. 2016 Aug;87(8):843-50. doi: 10.1136/jnnp-2015-312314. Epub 2016 Jan 18.
We investigated long-term (to 25 years) seizure prognosis and survival in people with newly diagnosed epilepsy in the community. We explored whether prognosis is different in those with epilepsy (>2 unprovoked seizures) and those with a single seizure at presentation.
This is a prospective observational cohort study of people with newly diagnosed seizures. We investigated seizure outcome and survival in people presenting with a single seizure and in those presenting with >2 seizures (epilepsy).
695 people (median follow-up 23.6 years) had unprovoked epileptic seizures. For seizure analysis we excluded 38 people with missing data leaving 657 (309 male, and 249 aged <18 years). Seizures recurred in 67%. The 354 people with epilepsy were only slightly more likely to have further seizure recurrence than the 302 people with a single seizure at presentation (HR 1.32, 95% CI 1.09 to 1.59). In 327 people with complete follow-up, 268 (82%, 95% CI 77% to 86%) were in terminal remission; (80%, (95% CI 73% to 85%) in those with epilepsy at presentation). Premature mortality was increased in people with epilepsy (standardised mortality ratio 1.67; 95% CI 1.40 to 1.99) and those with a single seizure at presentation (standardised mortality ratio 2.65; 95% CI 2.23 to 3.15). It is also high in those with early remission.
People with epilepsy and with single seizures at presentation in the community generally have good prognosis for seizure control with prolonged follow-up. The risk of premature mortality is significantly increased in both groups.
我们旨在研究社区中新诊断癫痫患者的长期（25 年）癫痫预后和生存率。我们探讨了在那些单次发作和多次发作（癫痫）患者中，预后是否存在差异。
这是一项对新诊断癫痫患者的前瞻性观察性队列研究。我们研究了单次发作和多次发作（癫痫）患者的癫痫转归和生存率。
695 人（中位随访 23.6 年）出现了无诱因癫痫发作。在进行癫痫分析时，我们排除了 38 名数据缺失的患者，最终纳入 657 名患者（309 名男性，249 名年龄<18 岁）。67%的患者癫痫发作复发。与单次发作的 302 名患者相比，患有癫痫的 354 名患者再次发生癫痫发作的可能性略高（HR 1.32，95%CI 1.09 至 1.59）。在 327 名完成随访的患者中，268 名（82%，95%CI 77%至 86%）处于最终缓解期；（80%，95%CI 73%至 85%）在首次就诊时就患有癫痫的患者中。患有癫痫的患者（标准化死亡率比 1.67；95%CI 1.40 至 1.99）和首次就诊时就有单次发作的患者（标准化死亡率比 2.65；95%CI 2.23 至 3.15）的过早死亡率增加。在早期缓解的患者中，死亡率也很高。
在社区中，患有癫痫和单次发作的患者在长期随访中通常具有良好的癫痫控制预后。两组患者的过早死亡率均显著增加。
