Gomez-Ibañez A, McLachlan R S, Mirsattari S M, Diosy D C, Burneo J G
Epilepsy Program, Department of Clinical Neurological Sciences, London Health Sciences Centre,Western University. 339 Windermere Road, London, N6A5A5 ON, Canada; Epilepsy Unit, Hospital Universitario y Politecnico La Fe, Avda. Fernando Abril Martorell, 106. 46026 Valencia, Spain.
Epilepsy Program, Department of Clinical Neurological Sciences, London Health Sciences Centre,Western University. 339 Windermere Road, London, N6A5A5 ON, Canada.
Epilepsy Res. 2017 Feb;130:69-73. doi: 10.1016/j.eplepsyres.2017.01.011. Epub 2017 Jan 28.
Idiopathic generalized epilepsy (IGE) is an epileptic condition with good response to antiepileptic drugs (AED). Major syndromes are epilepsy with generalized tonic-clonic seizures (GTCS) alone, absence epilepsy and juvenile myoclonic epilepsy. However, clinical practice shows drug-resistant patients. Endpoint is to identify clinical features related with refractoriness in IGE and in its each individual syndrome.
We retrospectively collected 279 consecutive patients with IGE assessed in the Epilepsy Clinic of our institution. We defined drug-resistant epilepsy as a failure of adequate trials of 2 tolerated and appropriately chosen and used AED schedules. We classified patients in two groups: drug-resistant and drug-responsive. Clinical features were compared among these groups, in the whole IGE group as well as in each syndrome.
There were 122 drug-resistant, 105 drug- responsive; 52 were undefined and excluded from the analysis. After multivariate analysis, early seizures onset (age <13), long-time epilepsy, several generalized seizure types, status epilepticus, EEG with generalized epileptiform activity, mainly polyspikes, and side effects with AED brought up as poor outcome factors. Additionally, 50.6% identified modifiable seizure triggers. Regarding syndromes, epilepsy with generalized tonic-clonic seizures alone had the same factors except several seizure types; presence of additional GTCS, polyspikes, history of AED side effects and psychiatric disorder were poor factors for absence epilepsy; only psychiatric comorbidity revealed significance in juvenile myoclonic epilepsy.
Refractoriness in IGE and its major syndromes is associated with clinical and electrographic parameters. Moreover, lifestyle advices from neurologists to the patients might help them to achieve a better seizure control.
特发性全身性癫痫（IGE）是一种对抗癫痫药物（AED）反应良好的癫痫病症。主要综合征包括仅伴有全身强直阵挛发作（GTCS）的癫痫、失神癫痫和青少年肌阵挛癫痫。然而，临床实践中存在耐药患者。研究终点是确定与IGE及其各单一综合征难治性相关的临床特征。
我们回顾性收集了在我院癫痫门诊评估的279例连续的IGE患者。我们将耐药性癫痫定义为对两种耐受性良好且选择和使用得当的AED治疗方案进行充分试验后仍治疗失败。我们将患者分为两组：耐药组和药物反应组。在这些组之间、整个IGE组以及各综合征中比较临床特征。
有122例耐药患者，105例药物反应患者；52例情况不明确，被排除在分析之外。多因素分析后，癫痫发作早（年龄<13岁）、癫痫病史长、多种全身性发作类型、癫痫持续状态、脑电图有全身性癫痫样活动（主要是多棘波）以及AED的副作用被提出作为不良预后因素。此外，50.6%的患者确定了可改变的发作诱因。关于综合征，仅伴有全身强直阵挛发作的癫痫具有相同的因素，但不包括多种发作类型；额外存在GTCS、多棘波、AED副作用史和精神障碍是失神癫痫的不良因素；仅精神共病在青少年肌阵挛癫痫中显示出显著性。
IGE及其主要综合征的难治性与临床和脑电图参数相关。此外，神经科医生给患者的生活方式建议可能有助于他们更好地控制癫痫发作。
