Morse Elliot, Giblin Kathryn, Chung Mi Hae, Dohle Carolin, Berg Anne T, Blumenfeld Hal
Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut, 06520, USA.
Department of Pediatric Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Epilepsy Res. 2019 May;152:7-10. doi: 10.1016/j.eplepsyres.2019.02.013. Epub 2019 Feb 25.
We retrospectively analyzed published studies to investigate historical trends in outcome of childhood absence epilepsy (CAE). We included patients based on onset of absence seizures in childhood, 3 Hz bilateral spike-wave discharges on EEG, and availability of seizure-free outcome data. The primary endpoint was seizure-freedom off medications by study publication year. We also analyzed relationships between seizure-freedom and 1. treatment medication, and 2. CAE diagnostic criteria. We included 29 studies published 1945-2013, encompassing 2416 patients. Seizure-freedom off medications was higher for studies after 1985 versus before 1975 (82% versus 35%; p < 0.001). Ethosuximide and valproate were used more commonly after 1985, and patients previously treated with ethosuximide or valproate had higher seizure-freedom off medications than those treated only with other medications (64% versus 32%; χ>10; p < 0.001). Although differences in diagnostic criteria for early vs. later studies did not reach statistical significance, later studies tended to use normal EEG background (p = 0.09) and absence of comorbid disorders (p = 0.09) as criteria more commonly. These findings demonstrate that seizure-freedom off medications has improved in published CAE studies after 1985. Our results are limited due to retrospective analysis. Further work is needed with prospective, controlled trials to establish factors leading to improved long-term prognosis in CAE.
我们回顾性分析已发表的研究，以调查儿童失神癫痫（CAE）的预后历史趋势。我们纳入的患者需符合儿童期出现失神发作、脑电图显示3Hz双侧棘慢波放电以及有癫痫发作缓解的预后数据。主要终点是根据研究发表年份计算的停药后无癫痫发作情况。我们还分析了癫痫发作缓解与以下因素的关系：1.治疗药物；2.CAE诊断标准。我们纳入了1945年至2013年发表的29项研究，涵盖2416例患者。1985年以后发表的研究中停药后无癫痫发作的比例高于1975年以前发表的研究（82%对35%；p<0.001）。1985年以后乙琥胺和丙戊酸的使用更为普遍，先前接受乙琥胺或丙戊酸治疗的患者停药后无癫痫发作的比例高于仅接受其他药物治疗的患者（64%对32%；χ>10；p<0.001）。尽管早期与后期研究的诊断标准差异未达到统计学意义，但后期研究更倾向于将脑电图背景正常（p=0.09）和无合并症（p=0.09）作为标准。这些发现表明，在已发表的CAE研究中，1985年以后停药后无癫痫发作的情况有所改善。由于是回顾性分析，我们的结果存在局限性。需要通过前瞻性对照试验进一步开展工作，以确定导致CAE长期预后改善的因素。
