初始单药长期疗效对癫痫患者撤药后复发的预测价值

The value of long-term efficacy of initial monotherapy in predicting recurrence in patients with epilepsy after antiepileptic drug withdrawal

目的探讨初始抗癫痫药物(AED)单药治疗的长期疗效对癫痫患者撤药后复发的预测价值,并分析与复发相关的临床因素。方法收集获得3年及以上无发作后开始撤药的癫痫患者171例,根据撤药前获得长期无发作的药物治疗方案,分为初始单药组(110例)与调整药物组(61例)。比较两组患者撤药后的复发率,并分析两组患者出现不同结局相关的临床因素。结果无癫痫发作患者撤药前服用的大多数AED平均处方日剂量/限定日剂量为中等或以下(30%~50%)。调整药物组撤药后复发率明显高于初始单药组(P=0.008)。单因素分析结果显示,调整药物组发病年龄>18岁、治疗前发作次数>10次及用药前病程>12个月的患者比例均明显高于初始单药组(P<0.05)。结论初始单药治疗失败后调整药物治疗方案获得长期无发作的患者,尤其在发病年龄>18岁、治疗前发作次数>10次及治疗前病程>12个月的情况下,撤药后复发率显著高于初始AED治疗即获得完全控制的患者。

Objective To explore the predictive value of long-term seizure control by initial antiepileptic drugs(AED)on seizure relapse in seizure-free patients with epilepsy after withdrawal,and to analyze the clinical factors related to recurrence.Methods A total of 171 epileptic patients who started to withdraw drugs after they had achieved seizure-free for 3 years or more were collected.According to the medicine treatment regiments before AED withdrawal,patients were divided into initial monotherapy group(110 cases)and adjusted drug group(61 cases).The recurrence rate after withdrawal between the two groups was compared,and the clinical factors related to different outcomes between the two groups were analyzed.Results The average daily dose/defined daily dose of most AED before withdrawal in seizurefree patients was moderate or lower(30%-50%).The relapse rate after withdrawal in the adjusted drug group was significantly higher than that of the initial monotherapy group(P=0.008).Univariate analysis showed that the proportion of patients with age of seizure onset>18 years old,patients with number of seizures before treatment>10 times and patients with course of epilepsy before treatment>12 months in the adjusted drug group were significantly higher than those in the initial monotherapy group(P<0.05).Conclusion Patients who achieved long-term seizure control by adjusted AED treatment after the initial AED failed,particularly the ones with age of seizure onset>18 years old,number of seizures before treatment>10 times and duration of epilepsy before treatment>12 months,had a higher recurrence rate after withdrawal compared to those controlled by initial AED treatment.