61例青春前期癫痫患儿减药、停药复发的危险因素分析

Analysis of Risk Factors Associated with Relapse after Dose-reduction and Withdrawal of Antiepileptic Drugs:A Study of 61 Prepubescent Children with Epilepsy

目的观察青春前期发病的癫痫患儿减药、停药后的复发情况,分析与复发相关的危险因素。方法收集2008年3月—2018年3月在笔者医院就诊的1月~10岁、经正规抗癫痫药物(AEDs)治疗3年以上无发作的癫痫患儿61例,依据减药、停药过程是否复发分为复发组和非复发组,采用Fisher确切概率法和χ2检验分析与癫痫复发相关的危险因素。结果复发组与非复发组的减药前、减药过程中、停药0.5 a内的视频脑电图(VEEG)显示痫样放电、擅自减药或停药的差别均有统计学意义(P=0.011,0.049,0.020,0.024),为癫痫复发的危险因素。两组患儿的家族史、头颅磁共振、停药0.5~1 a内VEEG、性别、年龄等方面的差别均无统计学意义(P>0.05)。结论青春前期发病的癫痫患儿减药时或停药后复发与多种因素相关,减药前、减药过程中、停药0.5年内的VEEG对预测癫痫复发有重要价值。擅自突然快速减药或停药可增加癫痫复发的可能性。

Objective To observe the epilepsy relapse of prepubertal children with epilepsy onset after drug reduction and withdrawal,and to evaluate the risk factors associated with relapse.Methods A collection of 61 children,aged 1 month to 10 years old with seizure-free epilepsy for morn than 3 years after treatment with regular anti-epileptic drugs in our hospital from March 2008 to March 2018,were divided into the recurrent group and non-recurrent group according to relapse or not after the drug reduction and withdrawal.Fisher’s exact test/Chi-square test was used to analyze and evaluate the risk factors related to epilepsy recurrence.Results The differences in epileptiform discharge as detected by video electroencephalogram(VEEG)in the patients of the recurrent group and non-recurrent group before and during drug reduction and within 0.5 years of drug withdrawal,unauthorized drug reduction or drug withdrawal were statistically significant(P=0.049,0.020,0.024),which are the risk factors for recurrence of epilepsy.However,there was no significant difference between two groups in family history,cranial MRI,VEEG within 0.5 to 1 year of drug discontinuation,gender and age,etc(P>0.05).Conclusion The relapse of epilepsy in prepubertal children during drug reduction or after drug withdrawal was associated with many factors.VEEG before drug reduction,during drug reduction,and within 0.5 years of drug withdrawal has important value in predicting epilepsy recurrence.Gradually reducing the drug according to the doctor's advice,and avoiding unauthorized sudden and rapid drug reduction or withdrawal can reduce the possibility of the epilepsy relapse.