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

作　　者：张旭[1] 向凤 时霄冰[1] 李杨 兰晓阳[1] 张世敏[1] 郎森阳[1] 王湘庆[1] Zhang Xu;Xiang Feng;Shi Xiaobing;Li Yang;Lan Xiaoyang;Zhang Shimin;Lang Senyang;Wang Xiangqing(Department of Neurology,First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心神经内科,北京100853

出　　处：《中华神经医学杂志》2024年第7期692-697,共6页Chinese Journal of Neuromedicine

基　　金：解放军总医院青年自主创新科学基金项目(22QNFC082)。

摘　　要：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 th

关 键 词：癫痫 老年 抗癫痫发作药物 疗效 

分 类 号：R742.1[医药卫生—神经病学与精神病学]