2 岁以内起病的癫痫患儿 7 岁时的结局：一项基于人群的研究。
Outcome at age 7 of epilepsy presenting in the first 2 years of life. A population-based study.
机构信息
Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Department of Pediatric Neurology, Karolinska University Hospital, Stockholm, Sweden.
出版信息
Epilepsia. 2022 Aug;63(8):2096-2107. doi: 10.1111/epi.17314. Epub 2022 Jun 25.
OBJECTIVE
Existing data suggest that epilepsy presenting in the first few years of life carries a worse prognosis than later onset. However, studies are few and methods differ, making interpretations of data uncertain. This study analyzes outcome at age 7 and potential prognostic factors in a well-characterized population-based cohort with epilepsy onset during the first 2 years of life.
METHODS
An incidence cohort of 116 prospectively identified cases of epilepsy with seizure onset before age 2 years was described in Stödberg et al. (2020). Cases were originally retrieved from the Stockholm Incidence Registry of Epilepsy (SIRE), which registered all cases with a first unprovoked epileptic seizure from September 1, 2001, in Northern Stockholm. Data on treatment and outcome at age 7 years were collected from electronic medical records and through interviews with parents. Outcome and potential prognostic factors were analyzed with descriptive statistics and multivariable log binomial regression analysis.
RESULTS
Eleven children (9.5%) died before age 7. Polytherapy was common. Epilepsy surgery was performed in two children. At age 7 years, 61 of 116 children (53%) had been seizure-free for the last 2 years or longer. Intellectual disability was diagnosed in 57 of 116 children (49%), autism spectrum disorder in 13 (11%), and cerebral palsy in 28 (24%). West syndrome had a similar seizure remission rate but a worse cognitive outcome. There was no difference in outcome between first and second year onset. Six predictors, including etiology, remained associated with two or more outcome variables after regression analysis.
SIGNIFICANCE
About half of children with infantile-onset epilepsy will become seizure-free and half of them will have intellectual disability. Etiology was confirmed as a major independent predictor of outcome. Our study contributes to a more firm knowledge base when counseling parents of infants diagnosed with epilepsy.
目的
现有数据表明，婴儿期起病的癫痫比晚发性癫痫预后更差。然而，研究较少，方法也不同，使得数据解释不确定。本研究分析了发病年龄在 2 岁以下的具有良好特征的基于人群的癫痫队列中 7 岁时的结局和潜在的预后因素。
方法
Stödberg 等人（2020 年）描述了一个前瞻性确定的 116 例癫痫发病年龄在 2 岁之前的癫痫发作的发病队列。病例最初从斯德哥尔摩癫痫发病登记处（SIRE）中检索到，该登记处从 2001 年 9 月 1 日起登记了所有在斯德哥尔摩北部首次无诱因癫痫发作的病例。7 岁时的治疗和结局数据是从电子病历中收集的，并通过与家长面谈收集的。使用描述性统计和多变量对数二项式回归分析来分析结局和潜在的预后因素。
结果
11 名儿童（9.5%）在 7 岁前死亡。联合治疗很常见。有两名儿童接受了癫痫手术。在 7 岁时，116 名儿童中有 61 名（53%）在过去 2 年或更长时间内无癫痫发作。116 名儿童中有 57 名（49%）被诊断为智力障碍，13 名（11%）被诊断为自闭症谱系障碍，28 名（24%）被诊断为脑瘫。West 综合征的癫痫缓解率相似，但认知结局较差。首次发病和第二年发病的结局没有差异。回归分析后，有 6 个预测因素，包括病因，与两个或更多结局变量相关。
意义
大约一半患有婴儿期起病的癫痫的儿童将无癫痫发作，而一半将有智力障碍。病因被确认为结局的主要独立预测因素。我们的研究为患有癫痫的婴儿的父母提供了更坚实的咨询基础。
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