Gesche Joanna, Cornwall Camilla Dyremose, Delcomyn Line, Rubboli Guido, Beier Christoph P
Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark.
Department of Neurology, Odense University Hospital, Denmark.
Epilepsy Behav. 2022 May;130:108633. doi: 10.1016/j.yebeh.2022.108633. Epub 2022 Mar 17.
The aim of the study was to determine risk factors associated with pseudoresistance in a large, representative cohort of patients with Idiopathic/Genetic Generalized Epilepsy (IGE) and the impact of pseudoresistance on socioeconomic parameters.
We performed a literature review on definitions of pseudoresistance in IGE. In an established cohort of patients with IGE from Funen, patients with current or previous pseudoresistant seizures were retrospectively identified based on a comprehensive evaluation of the patients' medical records and direct patient contact, if required. In addition, clinical characteristics, socioeconomic, and demographic data were assessed. Personal interviews were used to determine the brief version of Barratts (BIS-8) impulsivity score.
The literature review provided the following definition of pseudoresistance: Seizures due to (I) lacking adherence to antiseizure medication (ASM), (II) incompliance to general rule of conduct, (III) psychogenic nonepileptic seizures (PNES), (IV) inadequate choice of ASM/dosage, and (V) incorrect classification of epilepsy. Applying criteria I-III to a cohort of patients with IGE (n = 499), 73 patients (14.6%) were currently pseudoresistant and 62 (12.4%) were previously pseudoresistant, but currently seizure free. Current pseudoresistance was associated with younger age, drug/alcohol abuse, lower rate of full-time employment, and higher BIS-8 scores. We found no associations of pseudoresistance with juvenile myoclonic epilepsy, psychiatric disease, specific seizure types, or number of seizure types. Patients with previously pseudoresistant seizures have tried more ASMs and were characterized by male preponderance, higher BIS-8, and higher rates of abuse. Surrogate markers for social outcome did not differ.
In IGE, pseudoresistance may be defined as PNES or insufficient adherence to medication/conduct and is associated with younger age, drug/alcohol abuse, and higher scores for impulsivity. If transient, its impact on socioeconomic status remains limited but may be associated with a risk of overtreatment with ASM.
本研究旨在确定在一个大型、具有代表性的特发性/遗传性全身性癫痫（IGE）患者队列中与假性耐药相关的危险因素，以及假性耐药对社会经济参数的影响。
我们对IGE中假性耐药的定义进行了文献综述。在菲英岛一个已建立的IGE患者队列中，根据对患者病历的全面评估以及必要时与患者的直接接触，回顾性地确定目前或既往有假性耐药发作的患者。此外，还评估了临床特征、社会经济和人口统计学数据。通过个人访谈来确定巴雷特冲动性量表简版（BIS-8）得分。
文献综述给出了假性耐药的如下定义：由以下原因导致的发作：（I）未坚持服用抗癫痫药物（ASM），（II）不遵守一般行为规则，（III）精神性非癫痫性发作（PNES），（IV）ASM选择/剂量不当，以及（V）癫痫分类错误。将标准I-III应用于一个IGE患者队列（n = 499），73例患者（14.6%）目前存在假性耐药，62例（12.4%）既往有假性耐药但目前无癫痫发作。目前的假性耐药与年龄较小、药物/酒精滥用、全职就业率较低以及较高的BIS-8得分相关。我们未发现假性耐药与青少年肌阵挛癫痫、精神疾病、特定癫痫发作类型或癫痫发作类型数量之间存在关联。既往有假性耐药发作的患者尝试过更多的ASM，其特征为男性居多、BIS-8得分较高以及滥用率较高。社会结局的替代指标并无差异。
在IGE中，假性耐药可定义为PNES或对药物/行为的依从性不足，且与年龄较小、药物/酒精滥用以及较高的冲动性得分相关。如果是短暂性的，其对社会经济地位的影响仍然有限，但可能与ASM过度治疗的风险相关。
