Steinbart David, Grimmer Anja, Geelhaar Rebekka, Holtkamp Martin
Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Herzbergstr. 79 10365, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Department of Neurology, Augustenburger Platz 1 13353, Berlin, Germany.
Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Herzbergstr. 79 10365, Berlin, Germany.
Epilepsy Behav. 2025 Mar;164:110278. doi: 10.1016/j.yebeh.2025.110278. Epub 2025 Jan 23.
In people with intellectual disability (ID), prevalence of epilepsy can be over 40-times higher than in normally intelligent people, impacting quality of life (QoL) of those affected. Patients with ID are often excluded from clinical trials, resulting in limited evidence regarding treatment. This study aimed to evaluate effects of a comprehensive inpatient treatment program on seizure outcome and QoL and to identify predictive factors for improvement in these measures.
This prospective observational study included people with epilepsy (PWE) and ID (IQ < 70) who underwent comprehensive inpatient treatment in a tertiary epilepsy center. The program consisted of adjustments of anti-seizure medication (ASM) and various interventions such as occupational therapy, ergotherapy, logopedics, physiotherapy and counseling services, requiring a minimum hospital stay of 14 days. Outcome was measured by the Liverpool Seizure Severity Scale (LSSS), Glasgow Epilepsy Outcome Scale (GEOS), Aberrant Behavior Checklist (ABC), and Liverpool Adverse Events Profile (LAEP), alongside global QoL (numerical rating scale; 10 best, 0 worst) by caregivers. Seizure outcome was classified as "favorable" for patients experiencing not more than one seizure per month without any seizure-related injuries in the last 2 months. Data were collected within 2 weeks prior to admission and 8 weeks post-discharge. Wilcoxon signed rank tests and regression analysis were used to assess the effects of inpatient treatment and to identify predictive factors.
A total of 65 patients (30 female, median age 32 years) were included. During their hospital stays, number of ASM was reduced significantly, but not the total ASM dosage. Inpatient treatment led to a significant improvement in favorable seizure outcome (25 % before admission vs. 46 % after discharge; p = 0.004) and ASM adverse effects (LAEP median 34.0 vs. 31.0; p = 0.006). QoL ratings improved significantly post-treatment (rating scale median 4.0 vs. 6.0; p = 0.0015). A significant improvement of global QoL after discharge compared to the time point before admission was independently associated with a reduction of ASM number during hospital stay (p = 0.011). In general, higher global QoL after discharge was independently associated with a favorable seizure outcome (p < 0.001) and lower scores for ASM adverse effects (p = 0.03).
In PWE and ID, a comprehensive inpatient treatment program may be helpful to reduce burden of seizures and of ASM adverse effects as well as to improve global QoL. A reduction of the number of ASM may facilitate improvement of global QoL.
在智力残疾（ID）患者中，癫痫的患病率可能比智力正常的人高出40倍以上，这会影响患者的生活质量（QoL）。ID患者通常被排除在临床试验之外，导致治疗方面的证据有限。本研究旨在评估一项综合性住院治疗方案对癫痫发作结果和QoL的影响，并确定这些指标改善的预测因素。
这项前瞻性观察性研究纳入了在三级癫痫中心接受综合性住院治疗的癫痫患者（PWE）和ID患者（智商<70）。该方案包括调整抗癫痫药物（ASM）以及各种干预措施，如职业治疗、康复治疗、言语治疗、物理治疗和咨询服务，住院时间至少为14天。通过利物浦癫痫严重程度量表（LSSS）、格拉斯哥癫痫结果量表（GEOS）、异常行为检查表（ABC）和利物浦不良事件概况（LAEP），以及由护理人员进行的总体生活质量评分（数字评分量表；10分最佳，0分最差）来衡量结果。对于过去2个月内每月发作不超过一次且无任何癫痫相关损伤的患者，癫痫发作结果被分类为“良好”。在入院前2周内和出院后8周收集数据。采用Wilcoxon符号秩检验和回归分析来评估住院治疗的效果并确定预测因素。
共纳入65例患者（30例女性，中位年龄32岁）。在住院期间，ASM的种类显著减少，但ASM总剂量未减少。住院治疗使良好癫痫发作结果（入院前为25%，出院后为46%；p = 0.004）和ASM不良反应（LAEP中位数34.0对31.0；p = 0.006）有显著改善。治疗后QoL评分显著提高（评分量表中位数4.0对6.0；p = 0.0015）。与入院前时间点相比，出院后总体生活质量的显著改善与住院期间ASM种类的减少独立相关（p = 0.011）。一般来说，出院后较高的总体生活质量与良好的癫痫发作结果独立相关（p < 0.001），且与较低的ASM不良反应评分独立相关（p = 0.03）。
在PWE和ID患者中，一项综合性住院治疗方案可能有助于减轻癫痫发作负担和ASM不良反应，并改善总体生活质量。ASM种类减少可能有助于改善总体生活质量。
