Laboratory of Neurological Disorders, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy.
J Neurol Neurosurg Psychiatry. 2019 Nov;90(11):1276-1285. doi: 10.1136/jnnp-2019-320883. Epub 2019 Jun 27.
To describe the long-term prognosis of epilepsy and prognostic patterns in a large cohort of newly diagnosed patients and identify prognostic factors.
Study participants were 13 Italian epilepsy centres with accessible records dating back to 2005 or earlier, complete data on seizure outcome and treatments, precise epilepsy diagnosis, and follow-up of at least 10 years. Records were examined by trained neurology residents for demographics, seizure characteristics, neurological signs, psychiatric comorbidity, first electroencephalogram (EEG) and MRI/CT, epilepsy type and aetiology, antiepileptic drugs (AEDs), and 1-year, 2-year, 5-year and 10-year seizure remissions. Five predefined prognostic patterns were identified: early remission, late remission, relapsing-remitting course, worsening course and no remission. Prognostic factors were assessed using multinomial logistic regression models.
1006 children and adults were followed for 17 892 person-years (median 16 years; range 10-57). During follow-up, 923 patients (91.7%) experienced 1-year remission. 2-year, 5-year and 10-year remissions were present in 89.5%, 77.1% and 44.4% of cases. 5-year remission was associated with one to two seizures at diagnosis, generalised epilepsy, no psychiatric comorbidity, and treatment with one or two AEDs during follow-up. 10-year remission was associated with one or two AEDs. The most common prognostic pattern was relapsing-remitting (52.2%), followed by early remission (24.5%). 8.3% of cases experienced no remission. Predictors of a relapsing-remitting course were <6 seizures at diagnosis, (presumed) genetic aetiology and no psychiatric comorbidity.
Few seizures at diagnosis, generalised epilepsy and no psychiatric comorbidity predict early or late seizure freedom in epilepsy. Achieving remission at any time after the diagnosis does not exclude further relapses.
描述新诊断的大量患者的癫痫长期预后和预后模式，并确定预后因素。
研究参与者为意大利的 13 个癫痫中心，这些中心的记录可追溯到 2005 年或更早，具有完整的发作结局和治疗数据、精确的癫痫诊断以及至少 10 年的随访。由经过培训的神经科住院医师检查记录中的人口统计学数据、发作特征、神经体征、精神共病、首次脑电图（EEG）和 MRI/CT、癫痫类型和病因、抗癫痫药物（AEDs）以及 1 年、2 年、5 年和 10 年的发作缓解情况。确定了五种预设的预后模式：早期缓解、晚期缓解、缓解-复发病程、病情恶化和无缓解。使用多项逻辑回归模型评估预后因素。
1006 名儿童和成年人随访了 17892 人年（中位数 16 年；范围 10-57 年）。随访期间，923 名患者（91.7%）在 1 年内缓解。2 年、5 年和 10 年的缓解率分别为 89.5%、77.1%和 44.4%。5 年缓解与诊断时 1-2 次发作、全身性癫痫、无精神共病以及随访期间使用 1-2 种 AED 相关。10 年缓解与使用 1-2 种 AED 相关。最常见的预后模式是缓解-复发（52.2%），其次是早期缓解（24.5%）。8.3%的患者无缓解。缓解-复发病程的预测因素包括诊断时发作次数<6 次、（推测）遗传病因和无精神共病。
诊断时发作次数少、全身性癫痫和无精神共病可预测癫痫的早期或晚期发作自由。在诊断后任何时候达到缓解并不能排除进一步的复发。
