Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Sci Rep. 2018 Sep 13;8(1):13782. doi: 10.1038/s41598-018-31092-3.
This study aimed to investigate the impact of timing interval to start AED withdraw (TIW) after surgery on the seizure outcome in non-neoplastic drug resistant epilepsy (DRE). TIW were divided into three groups (respectively,<1 year, 1-<2 years, and ≥2 years). The seizure outcome at the different time points after starting AED withdrawal were compared among three groups. Other factors that related to seizure recurrence and TIW were included into the multiple analysis to investigate the predictors of seizure-free. Altogether, 205 patients were involved in the study. 102 individuals (50%) had seizure recurrence and 127 (62%) had seizure-free at the final follow up. 115 of them have attempted AED reduction and had not seizure recurrence before AED reduction. The rate of seizure-free had no significant difference among people with different TIW. Multiple analysis indicated that temporal surgery is a favorable predictor of seizure-free at the first year after starting AED withdrawal, and preoperative secondary generalized seizures is an unfavorable predictor of seizure-free at the final follow up. In patients with non-neoplastic DRE, TIW is not the mainly influence factor on seizure outcome, however, preoperative secondary generalized seizures and extra-temporal surgery are negatively associated with seizure-free.
本研究旨在探讨术后抗癫痫药物（AED）撤药时机（TIW）对非肿瘤性耐药性癫痫（DRE）患者癫痫发作结局的影响。TIW 分为三组（分别为<1 年、1-<2 年和≥2 年）。比较三组患者在开始 AED 停药后不同时间点的癫痫发作结局。将与癫痫复发和 TIW 相关的其他因素纳入多因素分析，以探讨无癫痫发作的预测因素。共有 205 例患者参与研究。102 例（50%）出现癫痫复发，127 例（62%）在最终随访时无癫痫发作。其中 115 例尝试减少 AED 剂量，在减少 AED 剂量前无癫痫发作。不同 TIW 患者的无癫痫发作率无显著差异。多因素分析表明，手术时间是开始 AED 停药后第一年无癫痫发作的有利预测因素，术前继发全面性癫痫发作是最终随访时无癫痫发作的不利预测因素。在非肿瘤性 DRE 患者中，TIW 不是癫痫发作结局的主要影响因素，而术前继发全面性癫痫发作和颞外手术与无癫痫发作呈负相关。
