耐药性部分性发作癫痫抗癫痫药物治疗观察及影响因素分析

摘要

Objective To explore the prognosis of patients of drug-resistant epilepsy with partial seizures after sequential treatment schedules with anti-epileptic drugs (AEDs) and identify the factors that affect the outcome of sequential treatment with AEDs.Methods A total of 97 patients of drug-resistant epilepsy with partial seizures continued to be treated with AEDs and then followed up for at least two years to observe the outcome of the treatment.Remission was defined as an achievement of at least one year free of seizures.The patients were divided into the effective group and the ineffective group according to the definition of remission.With univariate and multiple logistic regressions,we compared the clinical characteristics between the two groups to identify the factors that affect the outcome of sequential treatment with AEDs.Results Eighteen out of 97 patients were in remission and 12 patients relapsed at the follow-up; 79 cases had achieved no remission ever from the start to the end.Univariate logistic regression showed that more than 4 seizures per month before treatment (OR =3.973,95％ CI 1.202-13.136,P =0.024),more than 4 drugs failure before treatment (OR =3.269,95％ CI 1.063-10.047,P =0.039)had statistically significant correlation with the failure of sequential treatment with AEDs.There were no independent predictors of failure of AEDs with multiple logistic regression.Conclusions There is always hope of a meaningful seizure remission in patients of drug-resistant epilepsy with partial seizures,but the chance of relapse is above normal.More than 4 seizures per month before treatment and more than 4 drugs failure before treatment are associated with the failure sequential treatment of AEDs.%目的 探讨耐药性部分性发作癫痫患者继续使用抗癫痫药物(AEDs)治疗的效果及影响药物疗效的危险因素.方法 耐药性部分性发作癫痫患者97例,所有患者继续使用AEDs治疗,观察至少2a,根据观察期内是否达到至少1 a无发作将其分为缓解组和失败组,采用单因素和多因素Logistic回归分析探讨影响ADEs治疗效果的危险因素.结果 97例患者中,18例达到缓解(其中12例复发),79例始终未达到缓解(失败).单因素Logistic回归分析显示,治疗前发作频率≥4次/月(OR=3.973,95％CI1.202～ 13.136,P=0.024)、治疗失败药物数量≥4种(OR=3.269,95％ CI1.063～ 10.047,P=0.039)与ADEs治疗失败相关;多因素Logistic回归分析未显示AEDs治疗失败的预测因素.结论 耐药性部分性发作癫痫患者继续使用AEDs治疗,仍然有一定几率获得发作缓解,缓解后复发几率较高;治疗前发作频率≥4次/月、治疗失败药物数量≥4种与患者AEDs治疗效果不佳有关.