影响额叶癫预后的危险因素分析

Analysis of risk factors for prognosis of frontal lobe epilepsy

目的分析影响额叶癫预后的危险因素,以便早期预测难治性额叶癫,为临床早期合理治疗提供理论依据。方法采用病例对照研究(包括药物难治组47例和药物控制良好组92例),回顾性分析两组患者的临床资料,并对各种影响因素与预后的关系进行单因素和多因素分析,多因素分析采用Logistic逐步回归,前向逐步法。结果单因素分析表明首次发病年龄早、合理药物治疗前病程长、发作频繁(>1次/d)、姿势性发作、过度运动发作、继发全身强直-阵挛发作和既往有服药史7个因素对额叶癫的预后有不利影响(均P<0.05),Logistic逐步回归分析筛选出合理治疗前病程(OR=1.384,95%CI:1.133～1.689)和发作频率(OR=6.512,95%CI:1.637～25.911)是影响额叶癫预后的独立危险因素。结论合理药物治疗前病程长和发作频繁(>1次/d)是药物难治性额叶癫的重要危险因素,因此早期正确诊断和合理治疗有可能改善额叶癫的预后。

Objective To analyze the risk factors for the prognosis of frontal lobe epilepsy in order to predict the refractory frontal lobe epilepsy early, so as to provide theoretic basis for rational therapy early. Methods Forty-seven patients with medically refractory frontal lobe epilepsy and 92 patients with medically controllable epilepsy, totaly 139 patients, underwent epidemiological suvery, cranal CT or MRI, and videoelectroencephalography （VEEG）. Single factor analysis and Logistic stepwise regression analysis were done to analyze the relationship between the influential factors and the prognosis of disease. Result Single factor analysis showed that the factors including earlier onset age, longer duration before taking reasonable medicine, more frequent seizure （ 〉 1 time/day ） , asymmetric tonic seizures, seizures with hypermotor automatism, secondary generally tonic-clonic seizures, and a past history of taking medicine, exerted adverse effects on the prognosis of frontal lobe epilepsy（ all P 〈 0. 05 ）. Logistic stepwise regression analysis screened out such factors including duration before taking reasonable medicine（ OR = 1. 384,95% CI 1. 133-1. 689） and seizure frequency（ OR = 6. 512,95% CI 1. 637-25. 911 ） as independent predictors for the progosis of frontal lobe epilepsy. Conclusion Long duration before taking reasonable medicine and frequent seizure onset are important risk factors for refractory frontal lobe epilepsy. It is possible to improve the progosis of frontal lobe epilepsy by making a definite diagnosis and beginning rational therapy early.