耐药性部分性发作癫痫抗癫痫药物治疗观察及影响因素

Observation of Antiepileptic Drug Treatment for Drug-resistant Partial Seizure Epilepsy and Analysis of Influencing Factors

目的探讨使用抗癫痫药物(AEDs)治疗耐药性部分性发作癫痫的效果及影响其治疗的危险因素。方法选取2015年3月至2017年3月我科116例耐药性部分性发作癫痫患者为对象,所有患者均继续使用抗癫痫药物治疗,观察时间≥2年,按照观察期内“是否有≥1年时间无发作”的情况将患者分为缓解组、失败组,对ADEs治疗效果的危险因素进行多因素Logistic回归分析。结果有效缓解31例(26.72%),其中有复发22例(70.97%),保持缓解9例(29.03%);另85例(73.28%)失败。病程≥10年(OR=2.457,95%CI=0.598~6.579,P=0.025)、治疗前每月发病次数≥4次(OR=6.085,95%CI=3.133~20.370,P=0.021)、癫痫病持续发作时间≥30 min(OR=2.450,95%CI=1.236~3.793,P=0.026)、初期智力障碍(OR=4.063,95%CI=1.008~12.003,P=0.019)、治疗无效药物种类≥4种(OR=3.439,95%CI=1.169~13.689,P=0.007)为治疗失败的危险因素。结论使用AEDs治疗耐药性部分性发作癫痫仍然能够让患者有一定的发作缓解,但复发概率高。影响药效的危险因素包括:病程≥10年、治疗前每月发病次数≥4次、癫痫病持续发作时间≥30 min、初期智力障碍、治疗无效药物种类≥4种。

Objective To investigate the effect of anti-epileptic drugs(AEDs)in the treatment of drug-resistant partial seizure epilepsy and the risk factors affecting its efficacy.Methods All 116 patients with drug-resistant partial seizures in our department from March 2015 to March 2017 were selected.All patients continued to use antiepileptic drugs.The observation time was more than 2 years.According to the situation of"whether there was no seizure for more than 1 year"in the observation period,the patients were divided into remission group and failure group.The risk factors of treatment effect of ADEs were analyzed by multivariate logistic regression analysis.Results 31 cases(26.72%)were effective remission(please keep 2 decimal places),22 cases(70.97%)relapsed,9 cases(29.03%)maintained remission,and 85 cases(73.28%)failed.The course of disease was more than 10 years(OR=2.457,95%CI=0.598-6.579,P=0.025),the frequency of onset was more than 4 times per month before treatment(OR=6.085,95%CI=3.133-20.370,P=0.021),and The duration of epilepsy≥30 min(OR=2.450,95%CI=1.236-3.793,P=0.026),initial mental retardation(OR=4.063,95%CI=1.008-12.003,P=0.019)and more than 4 kinds of ineffective drugs(OR=3.439,95%CI=1.169-13.689,P=0.007)were risk factors for treatment failure.Conclusion Using antiepileptic drugs to treat drug-resistant partial seizure epilepsy can still relieve the patient's seizure to some extent,but the recurrence rate is high.Risk factors affecting drug efficacy include course of disease≥10 years,monthly incidence≥4 times before treatment,continuous seizure time≥30min of epilepsy,initial mental retardation,and≥4 kinds of ineffective drugs.