儿童难治性癫痫早期危险因素1GA6FA2病例对照Logistic回归分析

摘要

目的 分析癫痫患儿在发病初期的临床特点,探讨难治性癫痫(RE)患儿的高危因素,为临床及早处理RE提供依据.方法 收集147例诊断明确、治疗合理的癫痫患儿,分为药物难治性癫痫(DNR-EP)组(49例)和药物有效性癫痫(DR-EP)组(98例).观察癫痫患儿早期临床特点,采用多因素条件Logistic回归分析探讨RE患儿发病早期的危险因素.结果 单因素Logistic回归分析显示:初次发病年龄<1岁、初次治疗前1周发作次数>20次、局灶性癫痫发作、2种以上癫痫发作类型、病程中发作类型改变、神经功能缺损表现、早期智力障碍、头颅磁共振成像(MRI)异常、发作间期视频脑电图(VEEG)示固定局灶性异常、治疗前VEEG示弥散性非癫痫波样异常、初次抗癫痫药物(AEDs)治疗效果不佳、发病初期已符合癫痫性脑病特征的癫痫患儿在DNR-EP组中明显增多.上述表现再经过多因素条件Logistic回归分析,结果显示初次治疗前1周发作次数>20次(OR=2.679,P=0.043)、2种以上癫痫发作类型(OR=4.364,P=0.013)、发作间期VEEG示固定局灶性异常(OR=3.898,P=0.008)、初次AEDs治疗效果不佳(OR=2.611,P=0.036)、发病初期已符合癫痫性脑病特征(OR=6.022,P=0.002)是易发展为RE的高危因素.结论 初次治疗前1周发作次数>20次、2种以上癫痫发作类型、发作间期VEEG示固定局灶性异常、初次AEDs治疗效果不佳、发病初期已符合癫痫性脑病特征的癫痫患儿易发展为RE.%Objective To analyze the clinical characteristics of epileptic children at early stage,and to explore the high risk factors for children′s refractory epilepsy(RE)in order to provide evidence for the early and timely treatment of RE.Methods A total of 147 epileptic patients with correct diagnosis and reasonable treatment were enrolled.Forty-nine patients were classified as drug non-responsive epilepsy(DNR-EP group).The remaining 98 patients were classified as drug-responsive epilepsy(DR-EP group).With multiple conditional Logistic regression,the clinical characte-ristics between the 2 groups were compared to identify the early predictors for RE.Results Single factor Logistic regression analysis showed that the initial age of onset <1 year,more than 20 seizures before treatment in a week,focal seizures,more than 2 kinds of epileptic seizures,changes in seizure type in the course of disease,neurological impairment,early intellectual disability,abnormal cranial magnetic resonance imaging(MRI),fixed focal abnormalities on video electroencephalogram(VEEG) after seizure-free interval,diffused anomaly of non-epileptic wave in VEEG before treatment,poor response to initial antiepileptic drugs(AEDs) therapy,compliance with the characteristics of epileptic encephalopathy at early stage significantly increased in DNR-EP group.Then multivariate conditional Logistic regression analysis demonstrated that more than 20 seizures before treatment in a week(OR=2.679,P=0.043),more than 2 kinds of epileptic seizures(OR=4.364,P=0.013),fixed focal abnormalities on VEEG after seizure-free interval(OR=3.898,P=0.008),poor response to initial AEDs therapy(OR=2.611,P=0.036),and compliance with the characteristics of epileptic encephalopathy at early stage(OR=6.022,P=0.002) were the risk factors for developing into RE.Conclusions Children are likely to develop into RE if they have more than 20 seizures before treatment in a week,with more than 2 kinds of epileptic seizures,fixed focal abnormalities on VEEG after seizure-free intervals,poor response to initial AEDs therapy,and compliance with the characteristics of epileptic encephalopathy at early stage.