Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea.
Seizure. 2023 Jul;109:70-76. doi: 10.1016/j.seizure.2023.05.013. Epub 2023 May 17.
This study aimed to explore the natural history of patients with epilepsy using overall antiseizure-medication (ASM) treatment patterns on a nationwide scale in South Korea.
We investigated a retrospective longitudinal cohort of patients with epilepsy in South Korea using nationwide data from the Korean National Health Information Database of the Health Insurance and Review Assessment Service between January 1st, 2009, and December 31st, 2018. Histories of each patient's ASM prescription were followed for up to 7 years from the index date, the first observed date of ICD-10 epilepsy diagnosis codes with at least one ASM prescription.
Of 82,390 incident patients analyzed, ten thousand and fifty-nine were followed up to seven years, and nearly 60% of them discontinued the ASM(s). The proportion of patients with possible drug-resistant epilepsy (DRE), who experience three or more types of ASMs, gradually increased, reaching approximately 8.8% of the total number of patients in the seventh year (6.45% for adults, 21.8% for children). The duration of progression for half of the patients with possible DRE was 1.29 years for children, 1.79 years for adults, and 1.62 years for mixed-age patients. However, even in the sixth year, 72 cases progressed to possible DRE, and 6 cases with possible DRE discontinued ASMs in the next year, showing a dynamic process.
Our population-based study showed the dynamic changes of anti-seizure medication prescription in epilepsy patients with real-world data, which slowly stabilizes over years after the first diagnosis of epilepsy.
本研究旨在通过韩国全国范围内的整体抗癫痫药物（ASM）治疗模式，探索癫痫患者的自然史。
我们利用韩国健康保险和审查评估服务的全国性健康信息数据库，对 2009 年 1 月 1 日至 2018 年 12 月 31 日期间的韩国全国癫痫患者进行了回顾性纵向队列研究。从索引日期开始，对每位患者的 ASM 处方进行了长达 7 年的随访，索引日期为首次观察到 ICD-10 癫痫诊断代码且至少有一次 ASM 处方的日期。
在所分析的 82390 例新发病例中，有 1059 例患者进行了长达 7 年的随访，其中近 60%的患者停止了 ASM 治疗。经历三种或更多种 ASM 的可能药物难治性癫痫（DRE）患者的比例逐渐增加，在第七年达到了总患者数的约 8.8%（成人占 6.45%，儿童占 21.8%）。对于可能的 DRE 患者，一半患者的进展持续时间为儿童 1.29 年，成人 1.79 年，混合年龄患者 1.62 年。然而，即使在第六年，仍有 72 例进展为可能的 DRE，且在随后的一年中，有 6 例可能的 DRE 患者停止了 ASM 治疗，表明这是一个动态的过程。
本基于人群的研究显示了真实世界数据中癫痫患者抗癫痫药物处方的动态变化，在癫痫首次诊断后的几年内，处方逐渐稳定。
