Zhao Binyang, Liao Shuang, Zhong Xuefei, Luo Yuanyuan, Hong Siqi, Cheng Min, Zhang Jie, Li Tingsong, Jiang Li
Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, Department of Neurology, National Clinical Research Center for Child Health and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University (CHCMU), Chongqing, China.
Department of Rehabilitation, Children's Hospital of Chongqing Medical University, Chongqing, China.
Front Neurol. 2022 Jun 1;13:909191. doi: 10.3389/fneur.2022.909191. eCollection 2022.
This study aimed to compare the effectiveness and safety of oxcarbazepine (OXC) vs. levetiracetam (LEV) for treating infantile focal epilepsy in a longitudinal cohort study.
We enrolled 187 consecutive patients aged 2-24 months who received OXC or LEV as initial monotherapy; 161 patients completed the study. The longitudinal analysis involved anti-seizure medication (ASM) responsiveness, safety, the establishment of epilepsy syndrome, and etiology over a median follow-up of 2 years (interquartile range [IQR] 1.6-2.4). The relative efficacy and retention rates of OXC vs. LEV were evaluated using generalized linear regression models and the Cox proportional hazards model.
The 161 patients who completed the study had comparable baseline demographics and clinical variables between the OXC group ( = 83) and LEV group ( = 78). Overall, the mean age at onset was 6 months (IQR 4.3-9). The most common epilepsy syndrome was self-limited familial/non-familial infantile epilepsy (54.7%). Epilepsy was related to genetic and unknown causes in 34.2 and 52.2% of the patients, respectively. OXC achieved significantly higher responses than LEV for seizure freedom (risk ratio [RR] = 1.71, 95% confidence interval [CI] = 1.28-2.73, < 0.001) and 12-month retention rate after onset (hazard ratio [HR] = 1.84, 95% CI = 1.15-2.95, = 0.007). Moreover, OXC showed more obvious effects for patients aged < 1 year diagnosed with self-limited familial/non-familial infantile epilepsy and non-syndromic epilepsy with genetic or unknown causes. The adverse events related to both OXC and LEV were well-tolerated.
OXC could be an alternative to LEV for treating infantile focal epilepsy. OXC monotherapy can be considered first-line treatment for patients aged <12 months and those with epilepsy without developmental and epileptic encephalopathy.
在一项纵向队列研究中，比较奥卡西平（OXC）与左乙拉西坦（LEV）治疗婴儿局灶性癫痫的有效性和安全性。
我们纳入了187例年龄在2至24个月之间、接受OXC或LEV作为初始单药治疗的连续患者；161例患者完成了研究。纵向分析涉及抗癫痫药物（ASM）反应性、安全性、癫痫综合征的确定以及在中位随访2年（四分位间距[IQR] 1.6 - 2.4）期间的病因。使用广义线性回归模型和Cox比例风险模型评估OXC与LEV的相对疗效和保留率。
完成研究的161例患者在OXC组（n = 83）和LEV组（n = 78）之间具有可比的基线人口统计学和临床变量。总体而言，发病的平均年龄为6个月（IQR 4.3 - 9）。最常见的癫痫综合征是自限性家族性/非家族性婴儿癫痫（54.7%）。癫痫分别与34.2%和52.2%的患者的遗传和未知原因有关。在无癫痫发作方面，OXC的反应显著高于LEV（风险比[RR] = 1.71，95%置信区间[CI] = 1.28 - 2.73，P < 0.001），且发病后12个月的保留率（风险比[HR] = 1.84，95% CI = 1.15 - 2.95，P = 0.007）。此外，OXC对年龄小于1岁、诊断为自限性家族性/非家族性婴儿癫痫以及具有遗传或未知原因的非综合征性癫痫的患者显示出更明显的效果。与OXC和LEV相关的不良事件耐受性良好。
OXC可作为LEV治疗婴儿局灶性癫痫的替代药物。OXC单药治疗可被视为12个月以下患者以及无发育性和癫痫性脑病的癫痫患者的一线治疗方法。
