Berg A T, Shinnar S
School of Allied Health Professions, Program in Community Health, Williston Hall, Northern Illinois University, DeKalb 60115.
J Child Neurol. 1994 Oct;9 Suppl 2:19-26.
Up through the 1960s, studies of epilepsy were based on patients seen in tertiary referral centers, many of whom had refractory epilepsy. Based on these early studies, epilepsy was believed to be a chronic, progressive, and incurable disorder. Seizures were thought to cause damage and result in further seizures. Clinical management of children with seizures reflected these beliefs. Over the last 25 to 30 years, epidemiologic studies have demonstrated that, contrary to these earlier beliefs, the prognosis of most childhood seizures and epilepsy is excellent. Prognosis is largely determined by the underlying etiology and not the seizures themselves. The differences in the assessment of the prognosis of seizures derived from the earlier studies versus the later epidemiologic studies are largely due to several biases that occurred in the earlier studies. These biases are explained. Several examples are provided of how the epidemiologic studies have greatly altered the prevailing views regarding the prognosis of seizures, and, by doing so, the management of seizures.
直到20世纪60年代，癫痫研究都是基于在三级转诊中心就诊的患者，其中许多人患有难治性癫痫。基于这些早期研究，癫痫被认为是一种慢性、进行性且无法治愈的疾病。人们认为癫痫发作会造成损害并导致更多发作。对癫痫患儿的临床管理反映了这些观点。在过去25至30年中，流行病学研究表明，与这些早期观点相反，大多数儿童癫痫发作和癫痫的预后非常好。预后很大程度上取决于潜在病因，而非癫痫发作本身。早期研究与后来的流行病学研究在癫痫发作预后评估上的差异，很大程度上是由于早期研究中出现的几种偏差。这些偏差在此进行了解释。文中提供了几个例子，说明流行病学研究如何极大地改变了关于癫痫发作预后以及癫痫发作管理的主流观点。
