Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany.
Epilepsia. 2020 Dec;61(12):2685-2695. doi: 10.1111/epi.16720. Epub 2020 Oct 15.
To ascertain factors that are related to the antiepileptic drug load in epilepsy.
In this cross-sectional study, we analyzed a large cohort of conservatively treated patients with epilepsy (n = 1135) and a smaller homogeneous group of presurgical patients with neuropathologically confirmed unilateral hippocampal sclerosis (n = 91). Considered clinical variables comprised (1) presence of an underlying cerebral lesion, (2) onset and (3) duration of epilepsy, (4) seizure frequency, (5) generalized or focal to bilateral tonic-clonic seizures, (6) ictal impairment of awareness, and (7) a history of convulsive status epilepticus. In the presurgical sample, we additionally considered (8) the degree of pathology (hippocampal neuronal cell densities) instead of (1) presence of a cerebral lesion and (9) an overall rating of epilepsy severity (GASE scale). Drug load was quantified as (a) the number of concomitant antiepileptic drugs (AEDs) and (b) the total defined daily dose (DDD).
Analyses disclosed only small correlations between clinical variables and drug load indices. In the conservatively treated cohort, the multiple regression analyses revealed that epilepsy onset, cerebral lesion, history of convulsive status epilepticus, and seizure frequency combined explained only 6%-10% of variance in drug load. Nearly the same variance (5%-8%) could be explained by duration of epilepsy alone. Degree of hippocampal pathology and the epilepsy severity ratings were not related to drug load indices.
Clinical markers of epilepsy severity were only marginally associated with drug load. Findings rather indicate that patients seem to accumulate drugs due to the chronicity of epilepsy. Overall, the drug load remained largely unexplained. The findings nevertheless call for scrutinizing multidrug therapies in patients with long-lasting epilepsies.
确定与癫痫患者抗癫痫药物负荷相关的因素。
在这项横断面研究中，我们分析了一组保守治疗的癫痫患者（n=1135）和一组较小的、经神经病理学证实的单侧海马硬化症的术前患者（n=91）的大型队列。考虑的临床变量包括：（1）是否存在潜在的大脑病变；（2）发病时间和（3）癫痫持续时间；（4）癫痫发作频率；（5）全身性或局灶性双侧强直-阵挛性发作；（6）发作时意识障碍；（7）癫痫持续状态的病史。在术前样本中，我们还考虑了（8）病理学程度（海马神经元细胞密度）而不是（1）大脑病变的存在和（9）癫痫严重程度的总体评分（GASE 量表）。药物负荷的量化方法是：（a）同时使用的抗癫痫药物（AED）的数量和（b）总定义日剂量（DDD）。
分析仅显示临床变量与药物负荷指数之间存在很小的相关性。在保守治疗组中，多元回归分析显示，癫痫发病时间、大脑病变、癫痫持续状态的病史和发作频率共同解释了药物负荷的 6%-10%。仅癫痫持续时间就可以解释近 5%-8%的变异。海马病变程度和癫痫严重程度评分与药物负荷指数无关。
癫痫严重程度的临床标志物与药物负荷仅有轻微的相关性。研究结果表明，患者似乎由于癫痫的慢性而积累药物。总体而言，药物负荷在很大程度上仍未得到解释。但这些发现仍呼吁对长期癫痫患者的多药治疗进行仔细审查。
