Department of Residential Care, Epilepsy Center Kempenhaeghe, Heeze, the Netherlands.
Department of Neurology, Academic Center for Epileptology Kempenhaeghe, Maastricht University Medical Center, Heeze and Maastricht, the Netherlands; MHeNs School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands; School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Epilepsy Res. 2020 Nov;167:106461. doi: 10.1016/j.eplepsyres.2020.106461. Epub 2020 Sep 10.
The main objective of this cohort study is to determine the prevalence and incidence of morphometric vertebral fractures (VFs) over 7 years follow-up, in institutionalized adults with refractory epilepsy and intellectual disability (ID).
Dual-energy X-ray Absorptiometry (DXA) and Vertebral Fracture Assessment (VFA) were performed in 2009 and 2016. Vertebrae T4-L4 were assessed using quantitative morphometry. Severity of VFs was graded as 1 (mild; 20-25% reduction in height), 2 (moderate; 25-40% reduction) or 3 (severe; >40% reduction) according to the method described by Genant. Prevalent VFs were analyzed at baseline. VFs (grade 1, 2 or 3) present at follow-up, but not at baseline, were considered new VFs. Worsening VFs were defined as VFs with at least one grade deterioration at follow-up, compared to baseline (grade 1 to 2 or 3, or grade 2 to 3). Patients were treated with anti-osteoporosis treatment according to the Dutch guideline.
Baseline and follow-up DXA and VFA could be obtained in 141 patients (87 male) aged between 18-79 years old (mean 44.8 ± 15.7). At baseline, 56 patients had at least one prevalent VF. Patients with a prevalent VF were significantly older than patients without (49.2 ± 13.7 vs 41.9 ± 16.4, p < .01). After 7 years follow-up, 38 new VFs occurred in 27 patients and 15 patients had a worsening VF, leading to an overall cumulative incidence of 27.0%. VF incidence was significantly higher in patients with at least one prevalent VF at baseline (48.2% vs 12.9%, respectively, p < .01) compared to no VF.
In adults with refractory epilepsy VFA is challenging, due to physical and behavioral aspects, resulting in a substantial proportion of unevaluable vertebrae and scans. Nevertheless, 40% of the patients had a VF at baseline and after 7 years follow-up, 27% had at least one new and/or worsening VF despite adequate anti-osteoporosis treatment.
本队列研究的主要目的是确定在 7 年的随访中，患有难治性癫痫和智力障碍（ID）的机构化成年人中，形态计量性椎体骨折（VF）的发生率和患病率。
2009 年和 2016 年进行双能 X 射线吸收法（DXA）和椎体骨折评估（VFA）。使用定量形态计量学评估 T4-L4 椎体。根据 Genant 描述的方法，将 VF 的严重程度分为 1 级（轻度；高度减少 20-25%）、2 级（中度；高度减少 25-40%）或 3 级（重度；高度减少>40%）。在基线时分析现患 VF。在随访时出现但在基线时不存在的 VF（1 级、2 级或 3 级）被认为是新发 VF。与基线相比，随访时至少有一个等级恶化的 VF 被定义为恶化的 VF（1 级变为 2 级或 3 级，或 2 级变为 3 级）。根据荷兰指南，对患者进行抗骨质疏松治疗。
在 141 名年龄在 18-79 岁之间（平均 44.8 ± 15.7）的男性和女性患者中，可获得基线和随访时的 DXA 和 VFA。基线时，56 名患者至少有一个现患 VF。与无 VF 的患者相比，患有现患 VF 的患者年龄明显更大（49.2 ± 13.7 岁比 41.9 ± 16.4 岁，p <.01）。在 7 年的随访后，27 名患者中有 38 例新发 VF，15 名患者出现 VF 恶化，总累积发生率为 27.0%。与无 VF 相比，基线时至少有一个现患 VF 的患者 VF 发生率显著更高（分别为 48.2%和 12.9%，p <.01）。
在患有难治性癫痫的成年人中，由于身体和行为方面的原因，VFA 具有挑战性，导致大量椎体和扫描无法评估。然而，40%的患者在基线时有 VF，在 7 年的随访后，尽管进行了适当的抗骨质疏松治疗，仍有 27%的患者至少有一个新发和/或恶化的 VF。
