National Institute of Health and Medical Research, Unit 1094, Research Institute for Development, Unit 270, Université de Limoges, University Hospital Center of Limoges, EpiMaCT-Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France.
Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon.
Epilepsia. 2024 Oct;65(10):2995-3009. doi: 10.1111/epi.18100. Epub 2024 Aug 16.
Previous studies assessing factors associated with drug-resistant epilepsy (DRE) were constrained by their amalgamation of all epilepsy syndromes in their analyses and the absence of uniform criteria for defining DRE. Our objective was to identify predictors of DRE among the four primary childhood epilepsy syndrome groups within a cohort of children with new onset seizures, using the International League Against Epilepsy (ILAE) definition of DRE and the recent classification of epilepsies.
This is a prospective study of 676 children with new onset seizures initiated on antiseizure medication. Patients were monitored for the occurrence of DRE according to the ILAE criteria and were categorized into one of four epilepsy groups: self-limited focal epilepsies (SeLFEs), genetic generalized epilepsies (GGEs), developmental epileptic encephalopathies (DEEs), and focal epilepsies. Cox regression analysis was performed to identify predictors of DRE within each epilepsy group.
Overall, 29.3% of children were classified as having DRE, with the highest incidence observed among children diagnosed with DEEs (77.7%), followed by focal epilepsies (31.5%). Across the entire cohort, predictors of DRE included the presence of an epileptogenic lesion, a higher pretreatment number of seizures, experiencing multiple seizure types, presence and severity of intellectual and developmental delay, myoclonus, and younger age at epilepsy onset. Within the GGEs, only a younger age at seizure onset and experiencing multiple seizure types predicted DRE. Among focal epilepsies, predictors of DRE included the presence of an epileptogenic lesion, experiencing multiple seizure types, and having a greater number of pretreatment seizures. Within the DEEs, predictors of DRE were the occurrence of tonic seizures. Predictors of DRE within SeLFEs could not be identified.
This study indicates that different epilepsy syndromes are associated with distinct predictors of drug resistance. Anticipation of drug resistance within various groups is feasible using accessible clinical variables throughout the disease course.
既往评估耐药性癫痫（DRE）相关因素的研究受到其分析中合并所有癫痫综合征的限制，以及缺乏用于定义 DRE 的统一标准。我们的目的是在新发病例癫痫患儿队列中，使用国际抗癫痫联盟（ILAE）DRE 定义和最近的癫痫分类，确定四个主要儿童期癫痫综合征组中 DRE 的预测因素。
这是一项新发病例癫痫患儿（共 676 例）开始抗癫痫药物治疗的前瞻性研究。根据 ILAE 标准监测患者 DRE 的发生情况，并将其分为四个癫痫组之一：自限性局灶性癫痫（SeLFEs）、遗传性全面性癫痫（GGEs）、发育性癫痫性脑病（DEEs）和局灶性癫痫。采用 Cox 回归分析确定每个癫痫组中 DRE 的预测因素。
总体而言，29.3%的患儿被归类为 DRE，其中 DEEs 患儿的发生率最高（77.7%），其次是局灶性癫痫患儿（31.5%）。在整个队列中，DRE 的预测因素包括存在致痫性病变、治疗前发作次数较多、经历多种发作类型、存在和严重程度的智力和发育迟缓、肌阵挛和发病年龄较小。在 GGEs 中，只有发病年龄较小和经历多种发作类型预测 DRE。在局灶性癫痫中，DRE 的预测因素包括存在致痫性病变、经历多种发作类型和治疗前发作次数较多。在 DEEs 中，DRE 的预测因素是强直发作。SeLFEs 中 DRE 的预测因素无法确定。
本研究表明，不同的癫痫综合征与耐药的不同预测因素相关。在整个病程中，可以使用可获得的临床变量来预测各种类型癫痫患者耐药的发生。
