不同治疗时机对新诊断癫痫患者复发和预后的影响

Influence of different treatment time on the relapse and prognosis of patients with newly diagnosed epilepsy

目的探讨不同治疗时机对新诊断癫痫患者复发和预后的影响。方法前瞻性收集155例新诊断癫痫患者的临床资料，根据治疗前发作次数，分为即刻治疗组（≤3次，84例）和延迟治疗组（〉3次，71例），给予合理药物治疗，至少随访1年（中位数29个月）。采用Kaplan—Meier生存统计分析比较治疗后第1次发作时间和治疗失败时间[因疗效不佳和（或）不能耐受副作用而退出者]，同时比较2组患者观察期内“治疗失败”和“无发作”的比例。结果2组不同治疗时机癫痫患者第1次发作时间（即刻治疗组1484d，延迟治疗组1104d，x2=0．571，P=0．450）、治疗失败时间（即刻治疗组2992d，延迟治疗组1964d，X2=0．018，P=0．893）差异均无统计学意义；按病因（原发性、隐源或症状性）、年龄（儿童≤16岁，成人〉16岁）进行比较，2组差异亦均无统计学意义。观察期内即刻治疗组由于各种原因所致治疗失败患者20例（23．8％），延迟治疗组为16例（22．5％），差异无统计学意义（x2=0．035，P=0．852）；观察期内达“无发作“患者即刻治疗组40例（47．6％），延迟治疗组30例（42．3％），差异亦无统计学意义（x2=0．447，P=0．504）。结论对于治疗前发作次数较少（≤3次）的新诊断癫痫患者，即刻治疗不影响其复发和预后。

Objective To explore the influence of different treatment time on the relapse and prognosis of patients with newly diagnosed epilepsy. Methods To prospectively studied the clinical characteristics of 155 patients with newly diagnosed epilepsy. Patients were separated into immediate （n = 84, seizures ≤3 times） or deferred （n =71, seizures 〉3 times） treatment groups according to number of seizures before treatment with appropriate antiepileptic drugs （AEDs）. The patients were followed up for at least one year （median, 29 months）. Kaplan-Meier survival statistics was used to analyze time to first seizure or time to treatment failure （ inadequate seizure control and （or） intolerable side-effects ）. The proportions of patients with treatment failure and seizure free during follow up were also compared. Results There was no significant difference in time to first seizure or time to treatment failure between immediate （1484 days and 2992 days） and deferred treatment （1104 days and 1964 days; Log-Rank test x2 = 0. 571 and 0. 018 respectively, P = 0. 450 and 0. 893 ）. Subgroup analyses according to etiology （ primary and cryptogenic/ symptomatic epilepsy） and age （children ≤ 16 years; adult 〉 16 years） did not reveal any difference between immediate and deferred treatment. During follow up, there were 20 treatment failure patients （23.8%） in immediate treatment group and 16 （22.5%） in deferred treatment group （no statistical difference, x2 =0. 035 ,P =0. 852）. There were 40 seizure free patients （47.6%） in immediate treatment group and 30 （42. 3% ） in deferred treatment group （ no statistical difference, X2 = 0. 447, P = 0. 504）. Conclusions For newly diagnosed epilepsy patients with a few seizures （ seizures ≤3）, immediate AEDs treatment does not affect the relapse and prognosis.