癫（痫）患儿撤药后复发的相关因素

Factors predicting the risk of seizure relapse after antiepilepsy drug withdrawal in childhood epilepsy

目的 探讨癫（痫）患儿撤药后复发的相关因素.方法 回顾性分析2003年1月至2011年1月湖南省儿童医院癫（痫）患儿服用抗癫（痫）药物且临床已获控制2年以上无发作并撤药后复发的资料,门诊及电话随访至少2年.结果 127例入组患儿中,28例复发（22.05％）,男12/59例（20.34％）,女16/68例（23.53％）.婴儿期组复发8/44例（18.18％）,幼儿期组6/38例（15.79％）,学龄前期组8/34例（23.53％）,学龄期组6/11例（54.55％）;全面性发作复发12/87例（13.79％）,局限性发作复发16/40例（40.00％）.首次发作至使用癫（痫）药物时发作次数＜5次者中复发3/48例（6.25％）,5～10次者中复发13/54例（24.07％）,＞10次者中复发12/25例（48.00％）.单药治疗复发9/91例（9.89％）,联合治疗复发19/36例（52.78％）.正规抗癫（痫）治疗后至撤药时间中,2～3年组复发14/37例（37.84％）,3～4年组复发8/51例（15.69％）,4～5年组复发6/39例（15.38％）.撤药速度＜3个月组复发10/24例（41.67％）,3～6个月组复发9/36例（25.00％）,＞6个月组复发9/67例（13.43％）.起病年龄、发作类型、发作次数、用药方式、撤药时间及撤药速度与儿童癫（痫）撤药后复发相关,差异均有统计学意义（χ^2=8.051、6.780、16.896、27.607、7.576、8.451,P均＜0.05）.性别与复发无关（χ^2=0.187,P＞0.05）.结论 儿童癫（痫）患者的起病年龄、发作类型、发作次数、用药方式、撤药时间及撤药速度与撤药后复发相关,建议早期正规抗癫（痫）治疗,用药时间早、坚持用药至少3年、逐渐撤药时间＞6个月者,复发概率少。

Objective To investigate the factors associated with seizure relapse after antiepilepsy drug （AED） withdrawal in childhood epilepsy.Methods A retrospective analysis was conducted in epileptic children of Hunan Children＇s Hospital from Jan.2003 to Jan.2011.Among those with anti-epileptic therapy for seizure-free period over 2 years,the patients who relapsed after withdrawal were followed up through outpatient clinic visits and/or by telephone interviews for at least 2 years.Results Of the 127 cases of children enrolled in this study,28 patients（22.05%） relapsed [male：12/59 cases （20.34%） and female：16/68 cases （23.53%）].Cumulative relapse rates were 18.18% （8/44 cases） in infancy,15.79% （6/38 cases） in toddlers,23.53% （8/34 cases） in preschool children,and 54.55% （6/11 cases）in school age group.Of the patients who relapsed,generalized seizure occurred in 12/87 cases （13.79%）,partial seizure in 16/40 cases（40.00%）.According to seizure frequency between the first seizure and AED administration,3 cases（6.25%） relapsed among 48 cases of seizure frequency 〈 5 times,13 cases（24.07%） relapsed among 54 cases of seizure frequency 5 to 10 times,and 12 cases（48.00%） relapsed among 25 cases of seizure frequency more than 10 times.Relapse occurred in 9 cases of monotherapy（9/91 cases,9.89%） and in 19 cases of polytherapy （19/36 cases,52.78%）.According to the seizure control period （period between the beginning of antiepileptic treatment and AED withdrawal）,14 cases relapsed among 37 cases with the seizure control period of 2 to 3 years （37.84%）,8 cases relapsed among 51 cases with the period of 3 to 4 years （15.69%）,and 6 cases relapsed among 39 cases with the period of 4 to 5 years（15.38%）.According to AED tapering off period,10 cases relapsed among 24 cases with the period of 3 months （41.67%）,9 cases relapsed among 36 cases with the period of 3-6 mc ths （25.00%）,and 9 cases relapsed among 67 cases with the period of over 6 months（13.43%）.Factors associated with an increased risk of relapse were age of epilepsy onset,seizure type,route of administration,timing of antiepileptic trug withdrawal,tapering speed,which were had statistical significance （x =8.051,6.780,16.896,27.607,7.576,8.451,all P 〈0.05）.Gender difference was not associated with the risk of relapse（χ^2 =0.187,P 〉 0.05）.Conclusions Factors associated with an increased risk of relapse are age of epilepsy onset,seizure type,route of administration,timing of antiepileptic drug withdrawal,tapering speed.Standard therapies of early treatment,adherence to medication for at least 3 years,taper period for more than 6 months are associated with a decreased probability for relapse.