School of Medicine, University of Nottingham, Nottingham, NG7 2UH, United Kingdom.
Department of Paediatric Neurology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, United Kingdom.
Seizure. 2018 Jul;59:116-122. doi: 10.1016/j.seizure.2018.05.015. Epub 2018 May 20.
Conventional teaching is that juvenile myoclonic epilepsy (JME) and juvenile absence epilepsy (JAE) require lifelong antiepileptic drug (AED) treatment. We therefore wanted to determine how many patients attending our epilepsy service with JAE or JME went into 2 year remission, and then relapsed, both off and on AEDs.
This was a retrospective case-notes review. Patients with JAE and JME were systematically ascertained from clinic lists and databases at one teaching hospital. Data was extracted systematically. Simple descriptive statistics were used.
JAE: 14/36 (39%) were seizure free on AEDs for at least 2 years. Of the 6 (43%) attempting AED withdrawal, all (100%) relapsed, compared with only 25% of those who did not withdraw AEDs. Only 2/5 who relapsed and restarted AEDs regained remission. JME: 32/145 (22%) were seizure free on AEDs for at least 2 years. Of the 10 (31%) attempting AED withdrawal, 8 (80%) relapsed, compared with only 36% of those who did not withdraw AEDs. Only 2/8 who relapsed and restarted AEDs regained remission.
Remission rates for JAE and JME was lower than expected. Higher proportions of seizure free patients underwent physician-supervised withdrawal than anticipated. Relapse rates off AEDs were similar for JAE and JME, and at least twice as high as for those remaining on AEDs, and a further remission was not invariable on restarting AEDs. Our experience, comparing relapse in those withdrawing to those staying on AEDs will help in discussions with patients keen to try AED withdrawal.
传统观点认为青少年肌阵挛癫痫（JME）和青少年失神癫痫（JAE）需要终身抗癫痫药物（AED）治疗。因此，我们想确定在我们的癫痫服务中，有多少患有 JAE 或 JME 的患者在停药后 2 年内缓解，然后复发，无论是在 AED 治疗还是停药期间。
这是一项回顾性病例记录回顾。从一家教学医院的诊所名单和数据库中系统地确定 JAE 和 JME 患者。系统地提取数据。使用简单的描述性统计数据。
JAE：14/36（39%）在 AED 治疗下至少 2 年无癫痫发作。在尝试 AED 停药的 6 例（43%）中，所有（100%）复发，而未停药的患者仅为 25%。只有 2/5 例复发并重新开始 AED 治疗的患者恢复缓解。JME：32/145（22%）在 AED 治疗下至少 2 年无癫痫发作。在尝试 AED 停药的 10 例（31%）中，8 例（80%）复发，而未停药的患者仅为 36%。只有 2/8 例复发并重新开始 AED 治疗的患者恢复缓解。
JAE 和 JME 的缓解率低于预期。在接受医生监督的停药患者中，无癫痫发作的患者比例高于预期。停药后癫痫发作的复发率在 JAE 和 JME 中相似，至少是继续服用 AED 的患者的两倍，重新开始服用 AED 后不一定能再次缓解。我们的经验，比较停药和继续服用 AED 的患者的复发情况，将有助于与渴望尝试 AED 停药的患者进行讨论。
