Shafer S Q, Hauser W A, Annegers J F, Klass D W
Department of Neurology, Columbia University, New York, New York.
Epilepsia. 1988 Sep-Oct;29(5):590-600. doi: 10.1111/j.1528-1157.1988.tb03767.x.
The course of seizures was reviewed in all 306 residents of Rochester, Minnesota who had epilepsy diagnosed between 1935 and 1978, lived in the region greater than or equal to 5 years after diagnosis, and had an electroencephalogram (EEG). The life-table probability of having achieved 5 years seizure-free (FYSF) by 20 years after diagnosis was 75%. In a multivariable proportional hazards model, these three variables predicted a significantly higher rate of achieving FYSF: no early-life brain damage (remission rate ratio = 2.27, p less than 0.01), no generalized epileptiform activity (rate ratio = 1.58, p less than 0.05), and never having had a generalized tonic-clonic seizure (rate ratio = 1.4, p less than 0.05). The same three variables, plus age at diagnosis, were descriptors of the rate of reaching FYSF off medication. Gender, family history, type of seizure, and EEG findings other than generalized epileptiform activity were not significantly related to either end point. The predictor set did 15% better than prior probabilities in forecasting FYSF. Although informative about group experience, these predictors are weak clinical discriminators, singly or in a set. FYSF occurred in high proportion of even those persons whose history, clinical examination, or EEG findings placed them in a less favorable stratum of one or more predictors.
对明尼苏达州罗切斯特市的所有306名居民的癫痫发作病程进行了回顾，这些居民在1935年至1978年期间被诊断为癫痫，诊断后在该地区居住了5年或更长时间，并且进行了脑电图（EEG）检查。诊断后20年实现5年无癫痫发作（FYSF）的生命表概率为75%。在多变量比例风险模型中，这三个变量预测FYSF实现率显著更高：无早期脑损伤（缓解率比=2.27，p<0.01）、无全身性癫痫样活动（率比=1.58，p<0.05）以及从未有过全身性强直阵挛发作（率比=1.4，p<0.05）。这三个相同的变量，加上诊断时的年龄，是停药后达到FYSF率的描述指标。性别、家族史、癫痫发作类型以及除全身性癫痫样活动外的EEG结果与这两个终点均无显著相关性。该预测指标组在预测FYSF方面比先验概率提高了15%。尽管这些预测指标对群体经验有参考价值，但单独或组合起来，它们都是较弱的临床鉴别指标。即使是那些病史、临床检查或EEG结果使他们在一个或多个预测指标中处于不太有利分层的人，FYSF的发生率也很高。
