老年期起病癫痫患者的临床特征及药物疗效影响因素分析

Clinical characteristics of patients with elderly-onset epilepsy and influencing factors for medication efficacy

目的分析老年期起病癫痫患者的临床特征、药物治疗选择及疗效影响因素。方法回顾性纳入自1999年2月至2023年3月在解放军总医院第一医学中心神经内科癫痫门诊就诊的213例老年期起病癫痫患者(起病年龄均≥65岁),收集患者一般资料、影像学检查结果及随访结果等资料,回顾性分析患者发作频率、发作类型、服用药物种类及药物疗效。根据药物疗效将患者分为抗癫痫发作药物(ASMs)有效组及ASMs无效组,其中规律服用ASMs治疗至少6个月后无发作或发作次数减少50%以上定义为ASMs有效,发作次数减少不足50%或增加定义为ASMs无效。采用单因素及多因素Logistic回归分析明确影响ASMs疗效的因素。结果213例老年期癫痫起病患者中男性143例(67.1%),女性70例(32.9%);起病年龄为70.0(67.0,74.5)岁,病程12(4,32)个月。首次发作到接受治疗的时间为2.0(1.0,10.5)个月,<2个月患者占比最多(101例)。210行MRI/CT检查患者中102例存在潜在致痫性异常结构,包括脑卒中后神经胶质增生/脑软化(67例),以及外伤后胶质增生/脑软化(13例)等。78例非致痫异常结构患者中小血管缺血性改变最常见(51例)、其次为脑萎缩(15例)等。病因分类中,结构性病因最常见(160例)。ASMs治疗方面,69例(32.4%)患者就诊时未服药,服药患者144例(67.6%);丙戊酸钠应用最多(74例),其次为左乙拉西坦(35例)和卡马西平(24例);联合用药中最多的是丙戊酸钠联合左乙拉西坦(5例),其次为丙戊酸钠联合卡马西平(4例)。多因素Logistic回归分析结果显示病程较长及联合用药是ASMs疗效的独立危险因素。结论老年期起病癫痫患者以结构性病因为主。病程较长及联合用药患者药物疗效较差。

Objective To analyze the clinical characteristics and medication options of patients with elderly-onset epilepsy and influencing factors for medication efficacy.Methods A total of 213 patients with elderly-onset epilepsy(age of onset≥65 years)were selected from Epilepsy Outpatient,Department of Neurology,First Medical Center of Chinese PLA General Hospital from February 1999 to March 2023.General data,imaging findings and follow-up results of these patients were collected.Seizure frequencies and types,medication types,and medication efficacy were analyzed retrospectively.According to medication efficacy,these patients were divided into effective anti-seizure medications(ASMs)group and ineffective ASMs group effective ASMs was defined as having no seizures or seizure reduction>50%at 6 months after medication,and ineffective ASMs as having seizure reduction≤50%or seizure increase.Univariate and multivariate Logistic regression analyses were used to identify the influencing factor for ASMs efficacy.Results In these 213 patients with elderly-onset epilepsy,143(67.1%)were males and 70(32.9%)were females.Onset age was 70.0(67.0,74.5)years,with duration of 12(4,32)months.Time from first onset to treatment was 2.0(1.0,10.5)months,with that<2 months enjoying the largest proportion(n=101).MRI/CT in 102 patients indicated potential epileptogenic abnormal structures,such as post-stroke gliosis/encephalomalacia(n=67)and post-traumatic gliosis/encephalomalacia(n=13).MRI/CT in 78 patients indicated non-epileptogenic abnormal structures,such as ischemic changes of small and medium vessels(n=51)and brain atrophy(n=15).Structural change was the most common cause(n=160).Sixty-nine patients(32.4%)did not take medicine and 144(67.6%)took medicine at the visiting;sodium valproate was mostly used(n=74),followed by levetiracetam(n=35)and carbamazepine(n=24).Five patients had sodium valproate combined with levetiracetam,and 4 patients had sodium valproate combined with carbamazepine.Multivariate Logistic regression analysis showed that disease duration and medication combination were independent influencing factors for ASMs efficacy.Conclusion Structural change is the main cause for elderly-onset epilepsy;medication efficacy is worse in patients with longer disease course and medication combination therapy.