133例癫痫患儿撤药后复发危险因素分析

Analysis of risk factors for relapse of 133 epileptic children after withdrawal of drugs

目的回顾性分析癫痫患儿撤药后复发的危险因素,为其临床撤药提供参考依据。方法选取2017年1月—2019年3月就诊于徐州医科大学附属医院儿童神经科门诊的133例撤药癫痫患儿为研究对象,根据随访期间是否存在复发将癫痫患儿分为复发组(42例)和非复发组(91例),观察和比较两组性别、起病年龄、外伤史、治疗前发作频率、减药前脑电图(EEG)情况、影像学、用药种类、家族史、达控时间、治疗前病程、共患病、多种发作类型、撤药速度及治疗前EEG情况。结果两组患儿在撤药前EEG情况(χ^2=7.621)、用药种类(χ^2=8.760)、达控时间(χ^2=6.618)、治疗前病程(χ^2=6.435)、多种发作类型(χ^2=5.443)及有无癫痫共患病(χ^2=42.795)方面的差异均具有统计学意义(P均<0.05)。Logistic多元回归分析结果显示,癫痫患儿撤药后复发与撤药前EEG异常[OR=9.268,95%CI(2.255,38.092)]、联合用药治疗[OR=3.205,95%CI(1.159,8.866)]及治疗前病程>1年[OR=5.363,95%CI(1.781,16.150)]均具有相关性(P均<0.05)。结论撤药前EEG异常、联合用药、治疗前病程长的癫痫患儿应适当延长治疗时间,以降低癫痫患儿复发的可能性。

Objective The risk factors of relapse in 133 epileptic children after withdrawal were analyzed retrospectively and provide reference for clinical withdrawal.Methods From January 2017 to March 2019,133 children with withdrawal epilepsy were selected as the study object.According to whether there was recurrence during the followup period,the children with epilepsy were divided into recurrence group(42 cases)and non recurrence group(91 cases).The gender,age of onset,history of trauma,frequency of seizure before treatment,EEG before drug reduction,imaging,type of medication,family history,time of reaching control,course of disease before treatment,comorbidity,multiple attack types,withdrawal speed and EEG before treatment were observed and compared between the two groups.Results There were significant differences in EEG(χ^2=7.621),medication type(χ^2=8.760),time to control(χ^2=6.618),course before treatment(χ^2=6.435),multiple seizure types(χ^2=5.443)and epilepsy comorbidity(χ^2=42.795)between the two groups(P<0.05).The results of Logistic multiple regression analysis showed that the recurrence of epileptic children after drug reduction/withdrawal was correlated with abnormal EEG before drug reduction[OR=9.268,95%CI(2.255,38.092)],combined drug treatment[OR=3.205,95%CI(1.159,8.866)]and course of disease>1 year before treatment[OR=5.363,95%CI(1.781,16.150)](P<0.05).Conclusions In order to reduce the possibility of recurrence of epileptic children,the treatment time of epileptic children with abnormal EEG,combined medication and long course before treatment should be prolonged properly.