目的:这项前瞻性研究旨在描述人口统计学,自然发展,以及新诊断为癫痫伴单纯全身性强直阵挛性发作(EGTCA)患者的治疗反应。此外,我们的目标包括评估该队列中抗癫痫药物(ASM)停药后的癫痫复发率,同时探索癫痫复发的预测因素。
方法:研究队列,来自一个正在进行的,prospective,多中心调查儿童和成人的新出现的无缘无故的癫痫发作,纳入2010年3月至2020年3月纳入的连续患者,符合EGTCA诊断的强制性ILAE标准.参与者进行了3小时的睡眠剥夺视频EEG记录以及癫痫协议脑磁共振成像(MRI),每次随访时重复EEG。使用Kaplan-Meier生存分析计算癫痫发作复发的累积时间依赖性概率。Logistic回归确定了与ASM锥度后癫痫发作复发相关的变量。
结果:纳入89例中位年龄为16岁的患者,占被诊断为特发性全身性癫痫的31%。关于癫痫发作的昼夜节律分布,59.6%的患者仅经历了昼夜癫痫发作,12.4%完全是夜间活动,28.1%的人同时经历了昼夜和夜间癫痫发作。88%的患者的初始EEG中存在广义尖峰波放电(GSWD)。与未治疗患者的73%相比,14%的ASM患者GTC复发(p<0.00001)。在中位治疗时间为3年后,50例患者尝试停止ASM,44%的人经历了复发。患者开始的锥度和混合的昼夜节律发作模式独立地预测了ASM停药后复发的可能性更高。
结论:我们的发现强调了及时治疗对EGTCA诊断的重要性。值得注意的是,终身治疗可能不是必须的;患者至少2年无癫痫发作,在脑电图上没有GSWD的情况下,通常在ASM退出后保持癫痫发作自由,尤其是医生发起的逐渐减少。
结论:诊断为“癫痫伴单纯强直阵挛性癫痫发作”(EGTCA)的个体癫痫发作通常在青春期开始,并且通常对抗癫痫药物反应良好。脑电图,测量脑电波,将显示大多数EGTCA患者的异常放电。对于每个患有EGTCA的人来说,不需要使用抗癫痫药物进行终身治疗;大约,40%可以成功停止治疗而不面临癫痫复发。与在医生的监督下停止服药的患者相比,自行停止服药的患者癫痫发作复发的风险更高。
OBJECTIVE: This prospective study aimed to delineate the demographics, natural progression, and treatment response of patients newly diagnosed with epilepsy with generalized tonic-clonic seizures alone (EGTCA). Furthermore, our objective includes assessing the seizure recurrence rate post antiseizure medication (ASM) discontinuation within this cohort, alongside exploring predictive factors for seizure relapse.
METHODS: The study cohort, derived from an ongoing, prospective, multicenter investigation on children and adults with new-onset unprovoked seizures, included consecutive patients enrolled between March 2010 and March 2020, and meeting mandatory ILAE criteria for EGTCA diagnosis. Participants underwent a 3-h sleep-deprived video-EEG recording along with an epilepsy protocol brain magnetic resonance imaging (MRI) with repeat EEG at each follow-up. Cumulative time-dependent probabilities of seizure recurrence were calculated using Kaplan-Meier survival analysis. Logistic regression identified variables associated with seizure recurrence following ASM taper.
RESULTS: Eighty-nine patients with a median age of 16 years were included, constituting 31% of those diagnosed with an idiopathic generalized epilepsy. Regarding the circadian distribution of seizures, 59.6% of patients exclusively experienced diurnal seizures, 12.4% exclusively nocturnal, and 28.1% experienced both diurnal and nocturnal seizures. Generalized spike-wave discharges (GSWD) were present in the initial EEG of 88% of patients. A GTC recurred in 14% of patients treated with ASM compared with 73% of untreated patients (p < 0.00001). ASM discontinuation was attempted in 50 patients after a median treatment duration of 3 years, with 44% experiencing a recurrence. Patient-initiated taper and a mixed circadian seizure pattern independently predicted a higher likelihood of recurrence post-ASM discontinuation.
CONCLUSIONS: Our findings underscore the importance of prompt treatment upon the diagnosis of EGTCA. Notably, lifelong treatment may not be imperative; patients seizure-free for at least 2 years, with the absence of GSWD on EEG, often maintained seizure freedom after ASM withdrawal, especially with physician-initiated tapering.
CONCLUSIONS: Seizures in individuals diagnosed with \"epilepsy with generalized tonic-clonic seizures alone\" (EGTCA) typically start during adolescence and often respond well to antiseizure medications. An electroencephalogram, which measure brain waves, will show abnormal discharges in most patients with EGTCA. Lifelong treatment with antiseizure medication is not necessary for everyone with EGTCA; approximately, 40% can successfully stop treatment without facing seizure recurrence. Patients who stop medication on their own have a higher risk of seizures returning compared with those who undergo cessation under a doctor\'s supervision.