新诊断癫痫患者演变为难治性癫痫的发生率及危险因素探讨

Occurrence and predictors of drug resistance in a cohort with newly diagnosed epilepsy

目的调查新诊断癫痫患者中难治性癫痫（Refractory Ep ilepsy,RE）的发生率,探索早期预测RE的危险因素。方法以2009年RE新定义为标准,将新诊断癫痫患者分为RE组和非RE组,观察其RE的发生比例;通过单因素和多因素logistic回归分析,比较两组患者的临床特点,探索癫痫患者易发展为RE的预测因素。结果本研究共收集156例诊断明确、治疗合理的癫痫患者,平均随访5年,其中22例为RE患者,RE发生率为14.10%。单因素logistic回归分析显示：部分性发作、多种癫痫发作类型、病程中发作类型改变与RE有关;未发现性别、初次发病年龄、治疗前发作次数、睡眠中发作、隐源性或症状性癫痫、家族史、围产期危险因素史、热性惊厥史、既往脑损伤史、早期智能障碍、脑影像学异常、治疗前及治疗早期EEG异常与RE有关;多因素logistic回归分析显示：部分性癫痫发作（OR=4.13,95%C I 1.54~11.08,P=0.005）、病程中发作类型改变（OR=7.04,95%C I 1.19~41.66,P=0.031）是癫痫患者易发展为RE的预测因素。结论新诊断癫痫患者演变为RE的机率较低,部分性癫痫发作、病程中发作类型改变的癫痫患者易发展为RE。

Objective To investigate the proportion of newly diagnosed patients with refractory epilepsy（RE）and identify early predictors of RE.Methods Consecutive patients with newly diagnosed epilepsy were classified into two groups according to the new definition of RE devised by ILAE in 2009：refractory or non-refractory.With univariate and multiple logistic regression,we compared the clinical characteristics between the two groups to identify early predictors of RE.Results At the end of follow-up,we identified a total of 156 patients with correct diagnosis and reasonable treatment.Mean follow-up period was 5 years.22 patients who met the new definition were classified as RE group,and the remaining 134 patients were classified as non-refractory epilepsy group.The proportion of patients with refractory epilepsy was 14.10%.Strong univariate associations were noted between RE and following factors：partial seizures,mixed seizure type,changes in type of epilepsy during the clinical course.There were no univariate associations between RE and following factors：sex,age at seizure onset,more than 10 seizures before treatment,seizure at sleeping,cryptogenic or symptomatic epilepsy,family history of epilepsy,brain injured during perinatal period,febrile seizures,remote brain injured,mental retardation at the early time,abnormal brain imaging,abnormal EEG with epileptiform and slow wave.With multiple logistic regression,independent predictors of RE were partial seizures（OR=4.13,95%CI 1.54～11.08,P=0.005）and changes in type of epilepsy during the clinical course（OR=7.04,95%CI 1.19～41.66,P=0.031）.Conclusion A small proportion of patients with newly diagnosed epilepsy finally develop refractory epilepsy.Patients who have partial seizures and changes in type of epilepsy during the clinical course are likely to have refractory epilepsy.