不同年龄段成人首发癫痫的临床特征比较

Comparison of clinical characteristics of first-episode epilepsy in adults of different ages

目的探讨不同年龄段成年癫痫患者首发癫痫的临床特征。方法将292例成年首发癫痫患者分为青年组(18~44岁)、中年组(年龄45~59岁)和老年组(≥60岁)。比较各组病因、临床发作类型、EEG特点、影像学检查结果、基础疾病及用药情况。结果老年癫痫最常见的病因为缺血性卒中,青中年癫痫有多种病因,最常见病因尚不明确。青年组、中年组及老年组病因中缺血性卒中、自身免疫性脑炎、不明原因比率差异有统计学意义(均P<0.05)。青中年癫痫患者最常发生全面性发作,老年癫痫患者最常见局灶性发作。青年组、中年组及老年组单纯局灶性发作、全面性发作和非运动性发作比率差异有统计学意义(均P<0.05),EEG异常率差异无统计学意义(P>0.05)。青年组、中年组及老年组影像学异常率差异有统计学意义(P=0.000)。青年组、中年组及老年组间合并0~1种疾病、高血压、糖尿病、心血管疾病、缺血性卒中、神经系统变性疾病、CNS感染比率差异有统计学意义(均P<0.05)。青年组、中年组及老年组单药治疗、双药联合及三药联合比率差异无统计学意义(均P>0.05)。结论各年龄段首发癫痫的临床特征存在显著差异。老年癫痫最常见局灶性发作,主要病因是缺血性卒中,合并疾病多,影像学检查异常率高,常规EEG阳性率低。青中年癫痫患者最常见全面性发作形式,病因复杂,合并疾病少。

Objective To investigate the clinical characteristics of first-episode epilepsy in adults of different ages.Methods Two hundred and ninety-two adult patients with first-episode epilepsy were divided into the young group(18-44 years old),middle-aged group(45-59 years old)and elderly group(≥60 years old).The etiology,clinical seizure type,EEG characteristics,imaging examination results,basic diseases and medication were compared among the groups.Results The most common cause of epilepsy in elderly patients was ischemic stroke.There were many causes of epilepsy in young and middle-aged patient,and the most common cause was not clear.There were significant differences in the rates of ischemic stroke,autoimmune encephalitis and unexplained causes among the young,middle-aged and elderly groups(all P<0.05).The generalized seizure was most common in young and middle-aged patients with epilepsy,and focal seizure was most common in elderly patients with epilepsy.There were significant differences in the rates of simple focal seizure,generalized seizure and non-motor seizure among the young,middle-aged and elderly group(all P<0.05),and there was no significant difference in the abnormal rate of EEG(P>0.05).There were significant differences in the proportion of abnormal imaging among the the young,middle-aged and elderly group(P=0.000).There were significant differences in the rates of 0-1 diseases,hypertension,diabetes,cardiovascular disease,ischemic stroke,neurodegenerative disease and CNS infection among the the young,middle-aged and elderly group(all P<0.05).There was no significant difference in the rates of single-drug treatment,double-drug combination and triple-drug combination among the the young,middle-aged and elderly group(all P>0.05).Conclusions There are significant differences in the clinical characteristics of first-episode epilepsy among different age groups.Epilepsy in the elderly is mainly focal seizures,ischemic stroke is the main etiology,with more comorbidities,more abnormal imaging examinations,and lower abnormal electroencephalograms.While epilepsy in young and middle-aged patients is mainly generalized seizure,with complex etiologies and few comorbidities.