抗癫痫药物撤药后颞叶切除术后癫痫复发的结局。
Outcome after seizure recurrence on antiepileptic drug withdrawal following temporal lobectomy.
机构信息
From the R. Madhavan Nayar Center for Comprehensive Epilepsy Care (C.R., M.K.J., G.K.D., P.W., N.B., K.R.), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala; Department of Neurology (C.R.), Smt. B.K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat; Department of Neurology (M.K.J.), Stanley Medical College, Chennai, Tamilnadu; Department of Neurology (G.K.D.), Narayana Hrudayalaya Hospital, Bengaluru, Karnataka; Department of Neurology (P.W.), United CIIGMA Hospital, Aurangabad, Maharashtra; Department of Neurology (N.B.), Central Institute of Medical Sciences, Nagpur, Maharashtra; Achutha Menon Center for Health Science Studies (S.P.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala; and Amrita Advanced Epilepsy Centre (K.R.), Department of Neurology, Kochi, Kerala, India.
出版信息
Neurology. 2018 Jul 17;91(3):e208-e216. doi: 10.1212/WNL.0000000000005820. Epub 2018 Jun 20.
OBJECTIVE
To study the long-term outcome following seizure recurrence on antiepileptic drug (AED) withdrawal after anterior temporal lobectomy for mesial temporal lobe epilepsy.
METHODS
We retrospectively studied the AED profile of patients who had a minimum of 5 years of postoperative follow-up after anterior temporal lobectomy for mesial temporal lobe epilepsy. Only those patients with hippocampal sclerosis or normal MRI were included. AED withdrawal was initiated at 3 months in patients on ≥2 drugs and at 1 year for patients on a single drug.
RESULTS
Three hundred eighty-four patients with median postoperative follow-up of 12 years (range, 7-17 years) were included. Of them, 316 patients (82.3%) were seizure-free during the terminal 1 year. AED withdrawal was attempted in 326 patients (84.9%). At last follow-up, AEDs were discontinued in 207 patients (53.9%). Seizure recurrence occurred in 92 patients (28.2%) on attempted withdrawal. After a median postrecurrence follow-up of 7 years, 79 (86%) of them were seizure-free during the terminal 2 years. AEDs could be stopped in 17 patients (18.5%) and doses were reduced in another 57 patients (62%). Patients with febrile seizures, normal postoperative EEG at 1 year, and duration of epilepsy of <20 years (FND20 score) had 17% risk of seizure recurrence on attempted AED withdrawal. We also formulated a score to predict the chances of AED freedom for the whole cohort.
CONCLUSION
Patients with seizure recurrence on AED withdrawal have good outcome with 86% becoming seizure-free and 18% becoming drug-free after initial recurrence. A FND20 score helps in predicting recurrence on AED withdrawal.
目的
研究在接受内侧颞叶癫痫前颞叶切除术（TLE）后因停用抗癫痫药物（AED）而出现癫痫复发的长期结果。
方法
我们回顾性研究了至少术后 5 年随访的接受内侧颞叶癫痫前颞叶切除术的患者的 AED 概况。仅纳入海马硬化或 MRI 正常的患者。对于服用≥2 种药物的患者，在术后 3 个月开始停用 AED，对于服用单种药物的患者，在术后 1 年开始停用 AED。
结果
共有 384 例患者接受了中位数为 12 年（范围 7-17 年）的术后随访。其中 316 例（82.3%）在末次随访的最后 1 年内无癫痫发作。尝试停用 AED 的患者为 326 例（84.9%）。末次随访时，207 例（53.9%）患者停止服用 AED。在尝试停药的 326 例患者中，92 例（28.2%）出现癫痫复发。在中位复发后随访 7 年后，其中 79 例（86%）在末次随访的最后 2 年内无癫痫发作。17 例（18.5%）患者能够停药，另有 57 例（62%）患者减少了剂量。有热性惊厥史、术后 1 年 EEG 正常和癫痫持续时间<20 年（FND20 评分）的患者，有 17%的风险在尝试停用 AED 后出现癫痫复发。我们还制定了一个评分来预测整个队列中 AED 无发作的可能性。
结论
在尝试停用 AED 后出现癫痫复发的患者，有 86%的患者在复发后无癫痫发作，18%的患者无需服用药物，FND20 评分有助于预测停用 AED 后的复发风险。
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