Epilepsy Center, Department of Neurology, University Hospital, LMU Munich, Munich, Germany.
Epilepsy Center, Department of Neurology, University Hospital, LMU Munich, Munich, Germany.
Seizure. 2019 Apr;67:40-44. doi: 10.1016/j.seizure.2019.03.005. Epub 2019 Mar 8.
To systematically evaluate the duration of focal onset seizures under medication withdrawal as a function of drug half-life.
Adults with drug resistant focal epilepsy and invasive electroencephalographic (iEEG) recording between 01/2006 and 06/2016 (n = 128) were identified. Patients with multifocal or unknown epileptic foci were excluded, as well as subclinical seizures, isolated auras, or status epileptic. Antiepileptic drugs (AEDs) were withdrawn upon admission. The seizure duration was determined based on the invasive EEG data, and the latency since start of the monitoring was noted in hours. A negative binomial mixed model was used to compare the seizure durations before and after a cut-off, which was set at 2.5 half-lives of the individual anticonvulsive medication as this is thought to separate therapeutic and ineffective drug levels.
In total, 70 patients were included in the study and the duration of 672 seizures analyzed. On average, the patients were treated with 2.36 ± 0.78 AEDs. The individual cut-off of 2.5 half-lives was on average reached after 95.02 ± 80.18 h. The seizure frequency (321 vs. 351) and the rate of generalization (15.6% vs. 16.8%) was comparable before and after the individual cut-off point. The mean seizure duration was not statistically significantly prolonged after 2.5 half-lives by a factor of 1.168 for focal onset seizures (p = 0.090) and a factor of 1.091 for secondary generalized seizures (p = 0.545).
Although AED withdrawal increases the likelihood for epileptic seizures, it did not prolong the seizure duration, nor did it increase the rate of secondary generalization in our study.
系统评估药物撤药后局灶性起始发作的持续时间与药物半衰期的关系。
我们确定了 2006 年 1 月至 2016 年 6 月期间接受药物难治性局灶性癫痫和侵袭性脑电图（iEEG）记录的成人患者（n=128）。排除多灶性或未知癫痫灶的患者，以及亚临床发作、孤立先兆或癫痫持续状态。入院时停用抗癫痫药物（AED）。根据侵袭性脑电图数据确定发作持续时间，并记录从监测开始到发作的潜伏期，以小时为单位。使用负二项混合模型比较截点前后的发作持续时间，截点设定为个体抗惊厥药物半衰期的 2.5 倍，因为这被认为可以区分治疗和无效药物水平。
共有 70 例患者纳入研究，分析了 672 次发作的持续时间。平均而言，患者接受了 2.36±0.78 种 AED 治疗。个体截点 2.5 个半衰期的平均时间为 95.02±80.18 小时。在截点前后，发作频率（321 次与 351 次）和发作扩散率（15.6%与 16.8%）相似。在截点 2.5 个半衰期后，局灶性起始发作的平均发作持续时间没有显著延长，倍数为 1.168（p=0.090），继发性全身性发作的倍数为 1.091（p=0.545）。
尽管 AED 撤药增加了癫痫发作的可能性，但在我们的研究中，它并没有延长发作持续时间，也没有增加继发性全身性发作的发生率。
