Chen Hai, Amdur Richard, Pauldurai Jennifer, Koubeissi Mohamad
Department of Neurology, George Washington University, School of Medicine and Health Sciences, United States.
Department of Surgery, George Washington University, School of Medicine and Health Sciences, United States.
Epilepsy Behav. 2021 Oct 11;124:108330. doi: 10.1016/j.yebeh.2021.108330.
To identify the patterns and possible predictors of seizure recurrence after durable seizure freedom during maintenance of anti-seizure medication (ASM) treatment.
We conducted a retrospective longitudinal study that identified all adult individuals with epilepsy (IWE) at the George Washington University outpatient epilepsy clinic between 1/1/2014 and 12/31/2016 who had been seizure free for at least 2 years. We followed up the patients until 5/30/2020 for seizure recurrence. The data were analyzed using survival analysis, univariate analysis, and multivariate regression with Cox proportional hazard model. Outcomes were dichotomized into seizure relapse and seizure freedom. The total number of relapses and triggers of the initial relapse for individual patient were also analyzed.
This single-center cohort consisted of 220 IWE (age 21-80) of whom 99 patients had been seizure free for 2-3 years and 121 patients had been seizure free for more than 3 years. In this cohort, 48 patients (22%) experienced at least one seizure relapse during the span of the study. Of the relapsing patients, 25 (52%) had a single seizure relapse, and 8 (15%) had frequent seizure relapses (n ≥ 5) and developed pharmacoresistance. Half of the initial seizure relapses occurred without a trigger. Among those with at least one year of follow-up after relapsing (n = 33), 29 (86%) regained seizure freedom for at least 1 year. Among 26 patients with at least 2 years of follow-up, only 14 (55%) regained at least 2 years of seizure freedom. Previous longer duration of seizure freedom and ASM monotherapy predicted less chances of seizure relapse and fewer seizure numbers after relapse. No difference in prognosis was noted among relapsing patients between those with or without triggers.
Patients with well-controlled epilepsy may have seizure relapses with or without identifiable triggers. Most patients regained at least 1-year seizure freedom after the initial relapse, whereas about half patients reachieved 2-year seizure remission. About 15% of the relapsing patients may subsequently develop pharmacoresistance. Prognostic factors of seizure recurrences include duration of initial seizure remission and the number of ASMs used during remission. The presence of identifiable triggers for the initial seizure relapse does not predict future outcome.
确定在抗癫痫药物（ASM）维持治疗期间癫痫发作持续缓解后癫痫复发的模式及可能的预测因素。
我们进行了一项回顾性纵向研究，纳入了2014年1月1日至2016年12月31日期间在乔治·华盛顿大学门诊癫痫诊所就诊、癫痫发作至少持续缓解2年的所有成年癫痫患者（IWE）。我们对患者进行随访直至2020年5月30日，观察癫痫复发情况。采用生存分析、单因素分析以及Cox比例风险模型进行多因素回归分析数据。结局分为癫痫复发和癫痫发作持续缓解。还分析了个体患者复发的总次数及首次复发的诱因。
该单中心队列包括220例IWE（年龄21 - 80岁），其中99例患者癫痫发作持续缓解2 - 3年，121例患者癫痫发作持续缓解超过3年。在该队列中，48例患者（22%）在研究期间经历了至少一次癫痫复发。在复发患者中，25例（52%）仅有一次癫痫复发，8例（15%）频繁癫痫复发（n≥5次）并出现药物抵抗。半数首次癫痫复发无诱因。在复发后至少随访1年的患者中（n = 33），29例（86%）再次实现至少1年的癫痫发作持续缓解。在26例至少随访2年的患者中，只有14例（55%）再次实现至少2年的癫痫发作持续缓解。既往癫痫发作持续缓解时间较长及采用ASM单药治疗预示癫痫复发几率较低且复发后癫痫发作次数较少。复发患者中，有诱因和无诱因患者的预后无差异。
癫痫控制良好的患者可能会出现癫痫复发，有无可识别的诱因均可。大多数患者在首次复发后至少能再次实现1年的癫痫发作持续缓解，而约半数患者能再次实现2年的癫痫发作缓解。约15%的复发患者随后可能会出现药物抵抗。癫痫复发的预后因素包括首次癫痫发作缓解的持续时间以及缓解期使用的ASM数量。首次癫痫复发存在可识别的诱因并不能预测未来结局。
