Matricardi M, Brinciotti M, Benedetti P
Istituto di Neuropsichiatria Infantile, Università La Sapienza, Rome, Italy.
Epilepsia. 1989 Sep-Oct;30(5):582-9. doi: 10.1111/j.1528-1157.1989.tb05476.x.
We studied recurrence risks and predictive factors of relapse after antiepileptic drug (AED) discontinuation in a prospective analysis of 425 children with epilepsy who had not had a seizure for at least 2 years (follow-up after withdrawal 1.6-12 years, mean 8 years). Factors closely related by multivariate analysis to relapse were neurologic abnormalities, mental retardation, seizure type (infantile spasms, absence seizures), and appearance or persistence of EEG abnormalities during the course of the illness and before discontinuation. When multivariate analysis was performed to evaluate outcome of patients with a first relapse (isolated vs. multiple relapses), the variables closely related to a poor prognosis were etiologic factors, first relapse characterized by more than one seizure in a 24-h period, seizure-free period less than 4 years, unchanged seizure type at first relapse, more than one AED for seizure control, and abnormal EEG before the first relapse. In itself, resumption of therapy did not influence outcome. At the study cutoff point, 88% of patients with relapse were again seizure-free. We conclude that AEDs can safely be discontinued if predictive factors are considered to individualize the risk of relapse for each patient.
我们对425例至少2年无癫痫发作的癫痫患儿进行了前瞻性分析，研究了停用抗癫痫药物（AED）后的复发风险及复发的预测因素（停药后随访1.6 - 12年，平均8年）。多因素分析显示，与复发密切相关的因素包括神经系统异常、智力发育迟缓、癫痫发作类型（婴儿痉挛症、失神发作）以及病程中及停药前脑电图异常的出现或持续存在。在对首次复发患者（单次复发与多次复发）的预后进行多因素分析时，与预后不良密切相关的变量包括病因、首次复发表现为24小时内发作不止一次、无癫痫发作期少于4年、首次复发时癫痫发作类型未改变、控制癫痫发作使用一种以上AED以及首次复发前脑电图异常。治疗的恢复本身并不影响预后。在研究截止时，88%的复发患者再次无癫痫发作。我们得出结论，如果考虑预测因素以个体化每位患者的复发风险，AED可以安全停用。
