目的:首次无源性癫痫发作(FUS)后的患者管理可受益于进一步癫痫发作的平均50%风险的分层。我们用FUS表征受试者,从依法招募到以色列国防军的大量健康的同质士兵中,要调查服务类型的作用,作为触发负担替代品,有额外缉获的风险。
方法:2005年至2014年招募的士兵,在服役期间经历了FUS,是从军事记录中识别出来的.有癫痫史或缺乏FUS特征记录的受试者被排除在研究之外。人口统计数据,为符合条件的士兵提取了兵役和医疗细节。
结果:在816,252名新招募的士兵中,代表2,138,000人年,346有一个FUS,表明发病率为16.2/10万人年。与非战斗男性和女性士兵相比,战斗中的FUS发生率更高(p<0.0001)。大多数受试者(75.7%)服用了规定的抗癫痫药物(ASM),29.2%的受试者在FUS后有额外的癫痫发作。在作战部队服役,MRI异常和接受ASM处方与多次发作的风险较低相关(95%CI分别为0.48~0.97,0.09~0.86,0.15~0.28).在多变量分析中,在作战部队服役(癫痫发作复发的OR=0.48,95%CI0.26-0.88)和服用药物(OR=0.46,95%CI0.24-0.9)独立预测不会有额外的癫痫发作。
结论:战斗士兵的FUS发生率较高,但是他们的额外癫痫发作风险比非战斗士兵低两倍,强调剧烈触发因素作为癫痫发展的负面预测因素的价值。这表明癫痫的认知从“是或否”状态转变为持续的癫痫发作优势趋势,保证改变癫痫的病因加权和治疗方法。
OBJECTIVE: The management of patients after a first unprovoked seizure (FUS) can benefit from stratification of the average 50% risk for further seizures. We characterized subjects with FUSs, out of a large generally healthy homogenous population of soldiers recruited by law to the Israeli Defense Forces, to investigate the role of the type of service, as a trigger burden surrogate, in the risk for additional seizures.
METHODS: Soldiers recruited between 2005 and 2014, who experienced an FUS during their service, were identified from military records. Subjects with a history of epilepsy or lack of documentation of FUS characteristics were excluded from the study. Data on demographics and military service and medical details were extracted for the eligible soldiers.
RESULTS: Of 816 252 newly recruited soldiers, representing 2 138 000 person-years, 346 had an FUS, indicating an incidence rate of 16.2 per 100 000 person-years. The FUS incidence rate was higher in combat versus noncombat male and female soldiers (p < .0001). Most subjects (75.7%) were prescribed antiseizure medications (ASMs), and 29.2% had additional seizures after the FUS. Service in combat units, abnormal magnetic resonance imaging, and being prescribed ASMs were correlated with a lower risk of having multiple seizures (95% confidence interval [CI] = .48-.97, .09-.86, .15-.28, respectively). On multivariate analysis, service in combat units (odds ratio [OR] = .48 for seizure recurrence, 95% CI = .26-.88) and taking medications (OR = .46, 95% CI = .24-.9) independently predicted not having additional seizures.
CONCLUSIONS: FUS incidence rate was higher in combat soldiers, but they had a twofold lower risk of additional seizures than noncombat soldiers, emphasizing the value of strenuous triggers as negative predictors for developing epilepsy. This suggests a shift in the perception of epilepsy from a \"yes or no\" condition to a continuous trend of predisposition to seizures, warranting changes in the ways etiologies of epilepsy are weighted and treatments are delivered.