儿童特发性癫痫药物治疗停药后一年复发的因素分析

Analysis of the factors of recurrence after discontinuation of antiepileptic drugs in the first year in children with idiopathic epilepsy

目的 观察特发性癫痫患儿予抗癫痫药物(AEDs)治疗,疗程结束后停药1年内的复发情况,以及对可能影响复发的危险因素进行分析,为在今后儿科特发性癫痫患儿AEDs撤药的临床工作中,提供参考和借鉴.方法 收集201 1年1月-2014年1月广西医科大学第一附属医院儿科门诊和病房诊断为特发性癫痫并予AEDs治疗,疗程结束后撤药、至观察截止前停药已满1年的患儿125例,详细记录每个入组患儿的性别、癫痫发病年龄、癫痫发作类型、治疗前病程、开始AEDs治疗至最后一次发作之间的发作次数(达控前发作次数)、服用AEDs的种类、开始AEDs治疗至完全控制的时间(达控时间)、最后一次发作至开始撤药之间的时间(撤药时机)、开始撤药至完全停药的时间(撤药速度)、首次脑电图(EEG)、撤药前及撤药后的EEG表现以及复发情况等.使用多元逐步COX回归模型对收集的临床资料进行生存分析.结果 共收集125例特发性癫痫患儿,在撤药至停药后的第1年内,共有16例(12.8%)儿童复发;以复发时间为应变量,进行多变量COX回归模型分析显示,局灶性发作、撤药时机<3年、撤药后EEG异常的患儿其撤药后具有较高的复发风险.结论 特发性癫痫患儿AEDs撤药后复发的风险较低;特发性癫痫中的局灶性发作、发作控制时间<3年撤药、撤药后EEG异常的患儿撤药后具有较高的复发风险.

Obdective To observe the children with idiopathic epilepsy who received AED therapy and seizure-free,withdrawal at least 1 year,and analyze the risk factors of seizure recurrence.In order to give better instmctions for AED withdrawal of children with idiopathic epilepsy in pediatric depanment.Methods Children en with idiopathic epiIepsy who were seizure-free and had stopped AED treatment at least l year before the deadline of observation were collected from pediatric outpatient and inpatient depanment of the First Affiliated Hospital of Guangxi Medical University from January 2011 to January 2014.The following variables,derived from the case records were analyzed:sex,age at seizure onset,type of seizure,time period between the onset of the 6rst seizure and stan of treatment,number of seizures in the tiIne period between the start of AED thempy and the last seizure,number of AEDs before remission,time period between the start of AED therapy and the last seizure,time pedod between the last seizure and withdrawal of AED treatment(seizure-free period,timing of AED withdrawal),time period between the start of AED withdrawal and total discontinuation(speed of withdrawal),EEG registered at the time of diagnosis,before AED withdrawal,during and after AED withdrawal,and the condition of recuITence,data analysed by multi.variate step—wise Cox regression model analysis.Results A total of 16(12.8%)children relapsed in a total number of 125 children with idiopathic epilepsy we colleeted;date evaluated by multi—variable analysis showed that the children suffering from seizure type of focal seizure,staJting withdmwal after a seizure.free period of less than 3 years and with abnormal post-withdrawal EEG recording was associated with a higher risk of seizure recurrence.Conclusions Children with idiopathic epilepsy have a low risk of recun-ence after AED withdrawal.Those who suffer from seizure type of focal seizure,stan withdrawal after a seizure-free pedod of less than 3 years and with abnormal post-withdmwal EEG recording are associated with a higher risk of seizure recurrence.