Qi Jing, Liu Xiao, Xu Na, Wang Qun
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
National Center for Clinical Medicine of Neurological Diseases, Beijing, China.
Front Neurol. 2022 Feb 22;13:819889. doi: 10.3389/fneur.2022.819889. eCollection 2022.
To describe the clinical characteristics of elderly patients with new-onset epilepsy in a Class A tertiary comprehensive hospital in north China and evaluate the treatment outcomes of antiseizure medications (ASMs). This study focuses on investigating the factors affecting the treatment outcomes, guiding the drug treatment, and judging the prognosis of elderly epilepsy patients.
We included patients aged 60 years or older at the time of their first seizure between January 2014 and August 2020. Demographic characteristics, effects of ASM, and the proportion of 1-year and long-term seizure freedom were reported. The univariate analysis and binary logistic regression were used to identify factors potentially influencing treatment outcomes.
A total of 326 patients (median age 65 years, 67.2% men) were included. Moreover, 185 (56.7%) patients who received the first ASM monotherapy achieved 1 year of seizure freedom in the early stage. Compared with structural etiology, unknown etiology was associated with a higher likelihood of early seizure freedom (odds ratio [] = 0.545; < 0.05). Conversely, comorbid intracranial malignant tumors, taking carbamazepine (CBZ), and sodium valproate (VPA) were associated with a lower likelihood of seizure freedom ( = 3.527 vs. 6.550 vs. 8.829; < 0.05). At long-term follow-up, 263 (80.6%) patients achieved seizure freedom, with 79.8% on monotherapy.
Elderly patients with new-onset epilepsy responded well to the initial ASMs treatment. Patients with intracranial malignant tumors and prescribed VPA and CBZ were less likely to achieve early seizure freedom, while those with unknown etiology had higher probabilities of achieving early seizure freedom than those with structural etiology.
描述中国北方一家甲级三级综合医院中老年新发癫痫患者的临床特征，并评估抗癫痫药物（ASMs）的治疗效果。本研究着重于调查影响治疗效果的因素，指导药物治疗，并判断老年癫痫患者的预后。
纳入2014年1月至2020年8月首次发作时年龄在60岁及以上的患者。报告人口统计学特征、ASMs的效果以及1年和长期无癫痫发作的比例。采用单因素分析和二元逻辑回归来确定可能影响治疗效果的因素。
共纳入326例患者（中位年龄65岁，男性占67.2%）。此外，185例（56.7%）接受首次ASM单药治疗的患者在早期实现了1年无癫痫发作。与结构性病因相比，病因不明与早期无癫痫发作的可能性更高相关（比值比[] = 0.545；<0.05）。相反，合并颅内恶性肿瘤、服用卡马西平（CBZ）和丙戊酸钠（VPA）与无癫痫发作的可能性较低相关（= 3.527对6.550对8.829；<0.05）。在长期随访中，263例（80.6%）患者实现了无癫痫发作，其中79.8%接受单药治疗。
老年新发癫痫患者对初始ASM治疗反应良好。颅内恶性肿瘤患者以及使用VPA和CBZ治疗的患者早期无癫痫发作的可能性较小，而病因不明的患者比结构性病因患者早期无癫痫发作的概率更高。
