Refractory Epilepsy Unit, Neurology Service, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain; Department of Psychobiology/IDOCAL, University of Valencia, Avenida Blasco Ibáñez 21, 46010, Valencia, Spain.
Refractory Epilepsy Unit, Neurology Service, University Hospital La Fe, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain.
Epilepsy Behav. 2018 Mar;80:104-108. doi: 10.1016/j.yebeh.2017.12.033. Epub 2018 Feb 2.
Stimulation-evoked focal to bilateral tonic-clonic seizure (FBTCS) can be a stressful and possibly harmful adverse event for patients during cortical stimulation (CS). We evaluated if drug load reduction of antiepileptic drugs (AEDs) during CS increases the risk of stimulation-evoked FBTCS.
In this retrospective cohort study, we searched our local database for patients with drug-resistant epilepsy who underwent invasive video-EEG monitoring and CS in the University Hospital la Fe Valencia from January 2006 to November 2016. The AED drug load was calculated with the defined daily dose. We applied a uni- and multivariate logistic regression model to estimate the risk of stimulation-evoked FBTCS and evaluate possible influencing factors. Furthermore, we compared patients whose AEDs were completely withdrawn with those whose AEDs were not.
Fifty-eight patients met the inclusion criteria and were included in the analysis. Stimulating 3806 electrode contact pairs, 152 seizures were evoked in 28 patients (48.3%). Ten seizures (6.6%) in seven patients (12.1%) evolved to FBTCS. In the univariate and multivariate analysis, a 10% reduction in drug load was associated with an increase of the odds ratio (OR) of stimulation-evoked FBTCS by 1.9 (95%-CI 1.2, 4.0, p-value=0.04) and 1.9 (95%-CI 1.2, 4.6, p-value=0.04), respectively. In patients, whose AEDs were completely withdrawn the OR of FBTCS increased by 9.1 (95%CI 1.7, 69.9, p-value=0.01) compared with patients whose AEDs were not completely withdrawn. No other factor (implantation type, maximum stimulus intensity, number of stimulated contacts, history of FBTCS, age, gender, or epilepsy type) appears to have a significant effect on the risk of stimulation-evoked FBTCS.
The overall risk of stimulation-evoked FBTCS during CS is relatively low. However, a stronger reduction and, especially, a complete withdrawal of AEDs are associated with an increased risk of stimulation-evoked FBTCS.
皮质刺激（CS）过程中诱发的局灶到双侧强直阵挛发作（FBTCS）可能对患者造成压力，甚至可能带来伤害。我们评估了 CS 期间减少抗癫痫药物（AED）的药物负荷是否会增加诱发 FBTCS 的风险。
在这项回顾性队列研究中，我们在 2006 年 1 月至 2016 年 11 月期间，在瓦伦西亚 la Fe 大学医院对接受侵入性视频脑电图监测和 CS 的耐药性癫痫患者进行了本地数据库搜索。AED 药物负荷用规定日剂量计算。我们应用单变量和多变量逻辑回归模型来估计诱发 FBTCS 的风险，并评估可能的影响因素。此外，我们比较了完全停用 AED 药物的患者与未停用 AED 药物的患者。
58 名符合纳入标准的患者被纳入分析。在 3806 对电极接触对中进行刺激，在 28 名患者（48.3%）中诱发了 152 次发作。7 名患者（12.1%）中有 10 次发作（6.6%）进展为 FBTCS。在单变量和多变量分析中，药物负荷降低 10%，诱发 FBTCS 的优势比（OR）增加 1.9（95%CI 1.2，4.0，p 值=0.04）和 1.9（95%CI 1.2，4.6，p 值=0.04）。与未完全停用 AED 药物的患者相比，完全停用 AED 药物的患者 FBTCS 的 OR 增加了 9.1（95%CI 1.7，69.9，p 值=0.01）。没有其他因素（植入类型、最大刺激强度、刺激接触的数量、FBTCS 病史、年龄、性别或癫痫类型）似乎对诱发 FBTCS 的风险有显著影响。
CS 过程中诱发的 FBTCS 总体风险相对较低。然而，AED 药物的更大幅度减少，特别是完全停药，与诱发 FBTCS 的风险增加相关。
