Callaghan N, Garrett A, Goggin T
Department of Neurology, Cork Regional Hospital, Ireland.
N Engl J Med. 1988 Apr 14;318(15):942-6. doi: 10.1056/NEJM198804143181502.
We discontinued anticonvulsant drugs in 92 patients who had been free of seizures during two years of treatment with a single drug. All the patients had epilepsy that had previously been untreated, and had been randomly assigned to receive carbamazepine, phenytoin, or sodium valproate. Thirty-one patients relapsed, and 61 remained free of seizures. The mean duration of the follow-up in the patients remaining free of seizures was 35 months (range, 6 to 62). There was no significant difference between the relapse rate among adults (35 percent) and that among children (31 percent). Our results suggest that the number of seizures a patient had before control was achieved, the number of drugs tried as single-drug therapy, and the type of treatment withdrawn all influenced the outcome. Among the various types of seizures, complex partial seizures with secondary generalization carried the worst prognosis. In comparison, the risk of relapse was 65 percent lower in patients with generalized seizures and 97 percent lower in patients with complex or simple partial seizures in the absence of secondary generalized attacks. Among the four electroencephalographic classes, class 4 (abnormal before treatment and unchanged before withdrawal) carried the worst prognosis. The risk of relapse was 94 to 99 percent lower in patients in the other three electroencephalographic classes. Among the three anticonvulsants, withdrawal of sodium valproate carried the worst prognosis. In comparison, the odds of relapsing were 28 percent lower after withdrawal of phenytoin and 85 percent lower after withdrawal of carbamazepine. We conclude that withdrawal of anticonvulsant medication should be considered in patients free of seizures for two years.
我们对92例在单一药物治疗两年期间未发作癫痫的患者停用了抗惊厥药物。所有患者此前未经治疗，均被随机分配接受卡马西平、苯妥英或丙戊酸钠治疗。31例患者复发，61例仍未发作。仍未发作的患者的平均随访时间为35个月（范围为6至62个月）。成人复发率（35%）与儿童复发率（31%）之间无显著差异。我们的结果表明，患者在达到控制前的癫痫发作次数、作为单药治疗尝试的药物数量以及停用的治疗类型均会影响结果。在各种类型的癫痫发作中，伴有继发性全身性发作的复杂部分性发作预后最差。相比之下，全身性发作患者的复发风险低65%，无继发性全身性发作的复杂或简单部分性发作患者的复发风险低97%。在四种脑电图分类中，4类（治疗前异常且停药前无变化）预后最差。其他三种脑电图分类的患者复发风险低94%至99%。在三种抗惊厥药物中，停用丙戊酸钠预后最差。相比之下，停用苯妥英后复发几率低28%，停用卡马西平后复发几率低85%。我们得出结论，癫痫未发作两年的患者应考虑停用抗惊厥药物。
