Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.
Department of Pediatrics, Tottori Prefectural Rehabilitation Center for Children with Disabilities, Yonago, Japan.
Dev Med Child Neurol. 2019 Sep;61(9):1067-1073. doi: 10.1111/dmcn.14188. Epub 2019 Mar 10.
To assess the long-term natural course and prognosis of epilepsy in patients with cerebral palsy (CP).
We retrospectively collected data for 72 patients (36 males, 36 females) with CP who had epilepsy who visited our institutions between 1980 and 2015. The data from medical records, electroencephalography (EEG), and neuroimaging findings were reviewed. Time-to-event statistical analyses were performed to analyse the remission outcome and the Cox regression model was used for multivariate analyses.
Median age at onset of epilepsy was 2 years 0 months, and 17 years 0 months at the latest follow-up. In total, 34 patients (47%, 0.043 per person-year) achieved seizure remission at a median age of 11 years 0 months. Favourable factors for seizure remission included older age, motor disability being able to roll over/crawl but not able to sit, intellectual disability with an IQ between 36 and 70, normal findings on neuroimaging, and CP type other than spastic quadriplegia. In multivariate analysis, spastic quadriplegia was found to be associated with continued seizure activity. Antiepileptic drugs could be discontinued without relapse in 10 patients at a median age of 16 years 6 months, occurring 11 years 6 months after the onset of epilepsy. The drugs were terminated if the patient was aged at least 10 years and had perinatal causative aetiology and normalization or amelioration of epileptiform discharges on EEG.
The remission rate of epilepsy in CP increases up to young adulthood, and termination of antiepileptic drugs can be considered in selected cases at older ages.
The remission rate of epilepsy in cerebral palsy increases up to 20 years after onset. In some cases, antiepileptic drugs (AEDs) can be terminated without relapse. Older age, perinatal aetiology, and improvement on electroencephalography are favourable factors for terminating AEDs.
评估脑瘫（CP）患者癫痫的长期自然病程和预后。
我们回顾性收集了 1980 年至 2015 年间在我院就诊的 72 例 CP 伴癫痫患者的资料（男 36 例，女 36 例）。分析病历、脑电图（EEG）和神经影像学检查结果。采用生存分析评估缓解结果，采用 Cox 回归模型进行多变量分析。
癫痫发病年龄中位数为 2 岁 0 个月，末次随访时为 17 岁 0 个月。共 34 例（47%，0.043 人/年）在 11 岁 0 个月时达到缓解。癫痫缓解的有利因素包括年龄较大、运动障碍能翻身/爬行但不能坐、智商为 36 至 70 之间的智力障碍、神经影像学正常和痉挛性四肢瘫以外的 CP 类型。多变量分析发现痉挛性四肢瘫与持续癫痫活动有关。10 例患者在 16 岁 6 个月时停药，无复发，癫痫发病后 11 年 6 个月停药。如果患者年龄至少 10 岁，有围产期病因，脑电图痫样放电正常或改善，可终止药物治疗。
CP 癫痫的缓解率在成年后增加，在年龄较大的患者中，可以考虑在某些情况下终止抗癫痫药物治疗。
脑瘫患者癫痫的缓解率在发病后 20 年增加。在某些情况下，癫痫发作可在无复发的情况下停药。年龄较大、围产期病因和脑电图改善是终止抗癫痫药物治疗的有利因素。
