青少年新诊断癫痫的药物治疗结局：一项 30 年队列研究。

Pharmacological outcomes in teenagers with newly diagnosed epilepsy: A 30-year cohort study.

机构信息

University of Glasgow, Glasgow, Scotland, UK.

Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.

出版信息

Epilepsia. 2019 Jun;60(6):1083-1090. doi: 10.1111/epi.15664. Epub 2019 May 21.

DOI:10.1111/epi.15664

PMID:31111485

Abstract

OBJECTIVE

To evaluate the long-term pharmacological outcomes in teenagers with different epilepsies.

METHOD

This study included teenagers aged 13-19 years at treatment initiation who were newly treated with antiepileptic drugs (AEDs) at the epilepsy unit of the Western Infirmary in Glasgow, Scotland, between 1 September 1982 and 30 September 2012. Patients were prospectively followed until 30 April 2016, or death, with at least a 2-year follow-up.

RESULTS

A total of 332 adolescent patients (53% female; median age 16 years; 54% with generalized epilepsy) were included. At the end of the study, 221 patients (67%) were seizure-free. A higher seizure-free rate was observed in those with generalized compared to focal epilepsy (72% versus 60%, P = 0.01). During the study, 108 patients had relapses after periods of being seizure-free, most commonly due to poor adherence to AEDs (49%, n = 53/108). AED withdrawal was associated with a high risk of seizure recurrence (70%, n = 26/37), but 56% (n = 61/108) of relapsed patients became seizure-free again by the end of the study, with only 9% (n = 31/332) meeting the International League Against Epilepsy (ILAE) definition of pharmacoresistance during follow-up. Of the 221 seizure-free patients, 83% achieved this on monotherapy. There was no significant difference in efficacy rate between new and standard AED monotherapy (74% versus 77%, P = 0.66). The overall poor tolerability rate of AEDs was 21% (n = 69/332). Among the different new and standard AEDs used as initial monotherapy, lamotrigine was associated with the lowest rate of adverse effects (12%, n = 15/124), while topiramate was associated with the highest rate (56%, n = 5/9).

SIGNIFICANCE

Teenagers with epilepsy showed good seizure control, particularly those with generalized epilepsy. However, relapse was common and there was high risk of seizure recurrence after treatment withdrawal. Most patients were controlled on monotherapy. As the efficacy of AEDs was comparable, tolerability can be a primary consideration for AED selection in this population.

摘要

目的

评估不同癫痫青少年的长期药物治疗结局。

方法

本研究纳入了苏格兰格拉斯哥西部医院癫痫科于 1982 年 9 月 1 日至 2012 年 9 月 30 日期间新接受抗癫痫药物（AED）治疗的年龄在 13-19 岁的青少年患者。这些患者在研究中一直被前瞻性随访至 2016 年 4 月 30 日或死亡，随访时间至少 2 年。

结果

共纳入 332 例青少年患者（53%为女性；中位年龄 16 岁；54%为全面性癫痫）。研究结束时，221 例（67%）患者无癫痫发作。与局灶性癫痫相比，全面性癫痫患者的无癫痫发作率更高（72%比 60%，P=0.01）。在研究期间，108 例患者在无癫痫发作后复发，最常见的原因是 AED 依从性差（49%，n=53/108）。AED 停药与癫痫复发风险增加有关（70%，n=26/37），但在研究结束时，56%（n=61/108）的复发患者再次无癫痫发作，只有 9%（n=31/332）的患者在随访期间符合国际抗癫痫联盟（ILAE）的药物抵抗定义。在 221 例无癫痫发作的患者中，83%的患者单药治疗即可达到无癫痫发作。新 AED 与标准 AED 单药治疗的疗效无显著差异（74%比 77%，P=0.66）。AED 的总体不良耐受率为 21%（n=69/332）。在作为初始单药治疗的不同新 AED 和标准 AED 中，拉莫三嗪的不良反应发生率最低（12%，n=15/124），而托吡酯的不良反应发生率最高（56%，n=5/9）。