特发性全面强直阵挛癫痫撤药与复发危险因素的前瞻性研究

Prospective study of risk factor of recurrence after withdrawal of antiepileptic drug treatment in idiopathic generalized epilepsy with tonic-clonic seizure

目的观察抗癫痫药物(AEDs)有效控制的特发性全面强直阵挛发作癫痫患者在撤药后的复发情况,探讨影响复发的危险因素及缩短AEDs维持治疗时间的可能性。方法选择2005年10月至2008年10月间我院就诊的经AEDs有效控制特发性全面强直阵挛发作癫痫的患者,随机列入对照组(维持用药36个月逐渐减量至撤药)及研究组(维持用药24个月逐渐减量至撤药),指导其撤除AEDs,随访24个月,记录复发情况。采用Kaplan-Meier模型及Log-rank检验比较两组的复发率,应用Cox比例风险模型分析影响复发的危险因素。结果对照组46例患者复发14例,累积复发率为30.4%;研究组40例患者复发13例,累积复发率为32.5%。两组复发率比较差异无统计学意义(log-rank统计值=2.29,P=0.34)。Cox多因素分析表明,年龄、病程、发作频率及合并用药数是影响复发的重要危险因素。结论特发性全面强直阵挛发作患者经有效控制后维持用药24个月撤除药物并未增加复发的风险。根据患者的年龄、病程、发作频率、合并用药积极审慎地调整维持用药时间是可行的。

Objective To study the risk factor of recurrence after withdrawal of antiepileptic drug treatment in idiopathic generalized epilepsy with tonic-clonic seizures and analyze the risk factors of recurrence and the possibility for shortening the maintenance therapy.Methods Patients with idiopathic generalized tonic-clonic seizures attended our hospital from October,2005 to October,2008 who had accepted effective antiepilepsy treatment and had restrained the seizure for at least 24 months.All patients were arranged in control group（maintenance therapy for 36 months before withdrawal gradually） and study group（maintenance therapy for 24 months before withdrawal gradually） randomly.The patients were followed up for 24 months.Recurrence rate was estimated by Kaplan-Meier curves.Multiplicity of the factors that may be related with recurrence were performed using the Cox proportional hazards model.Results The recurrence in the control group was 30.4%（14/46）,and the research group was 32.5%（13/40）.There was no significant difference in the recurrence between two groups.Cox multiplicity showed that age,disease course,seizure frequency,drugs number were important risk factor of recurrence.Conclusion The risk of recrudescence had increased after 24 months of control effectively with the antiepileptic drug treatment.It is feasible that the maintained time of antiepileptic drug treatment actively adjust cautiously according to the age,disease course,seizure frequency and combination of drugs.