门诊癫痫患者初次单药治疗失败的长期结局观察并临床分析  

Long-term outcome observation and clinical analysis in the outpatients with epilepsy who had the failure of initial monotherapy

作　　者：何瑜玢 李竞一 汪雨萱 潘松青[4] He Yubin;Li Jingyi;Wang Yuxuan(Department of Medicine,Wuhan City College,Wuhan 430083)

机构地区：[1]武汉城市学院医学部,430083 [2]长江航运总医院脑科医院神经内科,430083 [3]武汉大学人民医院神经外科,430083 [4]武汉大学人民医院神经内科,430083

出　　处：《卒中与神经疾病》2024年第3期273-276,共4页Stroke and Nervous Diseases

基　　金：2022年度湖北省教育厅科学研究计划指导性项目(编号为B2022463)。

摘　　要：目的观察门诊癫痫患者初次单药治疗失败的长期结局并临床分析,以期为临床评估癫痫患者预后和制定治疗方案提供参考。方法从武汉大学人民医院癫痫门诊登记在册的患者资料中回顾并收集2008年3月-2021年6月初次单药治疗失败,能坚持遵医嘱规范化用药且定期门诊复诊(≥5年)的癫痫患者的详细病情,并进行统计学分析。结果共收集104例,其中男性患者63例,女性患者41例;平均年龄(20.14±14.31)岁,平均病程(10.33±5.86)年,均坚持随访到第6年,第7年开始逐渐失访;第1~6年每年发作例数及比例依次为95例(91.3%)、76例(73.1%)、64例(61.5%)、49例(47.1%)、51例(49%)、57例(54.8%);6年内均临床无发作3例(2.9%),每年有发作32例(30.8%),连续控制2~5年临床无发作后复发69例(66.3%);以第6年为研究终点,连续第2、3、4和5年临床无发作后复发情况依次为2/16(12.5%)、13/23(56.5%)、3/11(27.3%)、1/4(25%);对比分析第6年发作组和未发作组患者就诊前资料,发现其中颅脑疾病/外伤、头颅磁共振成像(Magnetic resonance imaging,MRI)/头颅计算机X线断层扫描(Computed tomography,CT)异常(P<0.05)。结论既往癫痫病程10年左右、颅脑疾病/外伤、头颅MRI/CT异常且首次规范抗癫痫单药治疗失败患者不易控制发作,可能是难治性癫痫的高危因素;以连续3年临床无发作后复发率最高,建议此类患者临床延迟减量、撤药和停药时间,并积极考虑是否适宜癫痫手术治疗。Objective To provide the reference for clinical prognosis evaluations and therapeutic schedule by observing the long-term outcome of outpatients with epilepsy experiencing initial monotherapy failure.Methods Thousands of patients with epilepsy were registered in the epilepsy outpatient department of Renmin Hospital of Wuhan University from March 2008 to June 2021.We reviewed and collected the detailed data of the patients who experienced failure of the first single drug treatment,adhered to the standardized anti-epileptic therapy as prescribed by the doctor and clinical follow-up regularly(≥5 years).The modernstatistical methods were used to analyse the above data.Results A total of 104 cases were collected,including 63 males and 41 females.The average age of patients was 20.14 years old.The average course of epilepsy disease was 10.33 years.All of them were followed up to the 6th year,but some were gradually lost since the 7th year.The proportion of annual epileptic seizure were 95(91.3%),76(73.1%),64(61.5%),49(47.1%),51(49%),and 57(54.8%)from the first year to the sixth year,respectively.During the six years,there were 3 cases(2.9%)with no epileptic seizure,32 cases(30.8%)with epileptic seizure every year and 69 cases(66.3%)with recurrence after two to five years of no epileptic seizure.At the 6th year,the end point of the study,the recurrence situation of patients who had no epileptic seizure for two to five years were 2/16(12.5%),13/23(56.5%),3/11(27.3%)and 1/4(25%).The data of patients in the seizure group and the non-seizure group at the 6th year were analyzed.It was found that craniocerebral disease or trauma and head MRI/CT abnormalities were more common in the seizure group(P<0.05).Conclusion The seizure was relatively hard to control in patients with a long history of epilepsy for about 10 years,craniocerebral disease or trauma,abnormal head MRI/CT images,and the failure of the first standardized antiepileptic monotherapy which may be high risk factors for refractory epilepsy.The highest recurrence ra

关 键 词：初次单药失败 长期结局难治性癫痫复发 癫痫手术 

分 类 号：R742.1[医药卫生—神经病学与精神病学]