Characteristics and treatment of midlife-onset epilepsy: A 24-year single-center, retrospective study

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-06-19 DOI:10.1002/epd2.20253

Xu Zhang, Feng Xiang, Xiaobing Shi, Ziyu Wang, Yang Li, Shimin Zhang, Xiaoyang Lan, Senyang Lang, Xiangqing Wang

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引用次数: 0

Abstract

Objective

This study aimed to analyze the clinical characteristics, etiology, and treatment of midlife-onset epilepsy in a real-world setting at a single center in China.

Methods

The clinical data of patients who attended the epilepsy clinic of the Department of Neurology, First Medical Center of Chinese PLA General Hospital from February 1999 to March 2023 were retrospectively analyzed. The clinical characteristics, etiology, and risk factors for midlife-onset epilepsy over the past 24 years were analyzed.

Results

Of the 969 patients with onset at 45–64 years of age, 914 were diagnosed with epilepsy with at least two unprovoked seizures 24 h apart. Of those, 99.7% (911) were of focal origin. The median duration from the initial seizure to follow-up treatment was 2 months (interquartile range [IQR]: 1.0–6.0 months). Before commencing treatment, 30.2% (207/683) of patients experienced more than two seizures. A structural etiology was found in 66.3% (606/914) of patients. Cerebrovascular disease (CVD) and traumatic brain injury (TBI) accounted for 19.9% (182/914) and 16.6% (152/914) of the cases, respectively. Logistic regression analysis showed that patients with abnormal imaging (odds ratio [OR] 2.04; 95% confidence interval [CI] 1.25–3.32; p = .004), focal seizures (OR 2.98; 95%CI 1.82–4.87; p < .001), and seizure clusters (OR 2.40; 95%CI 1.21–4.73; p = .01) had poor drug responses. Treatment outcomes were generally better in patients with epilepsy after CVD (OR .49; 95%CI .28–.85; p = .01). Treatment initiation after two seizures (OR .70; 95%CI .42–1.15; p = .16) or 6 months after the first seizure (OR 1.17; 95%CI .66–2.09; p = .58) did not result in poor drug effectiveness.

Significance

Midlife-onset epilepsy is typically of focal etiology, with CVD being the most common cause, and tends to respond well to medication. The median duration from the initial seizure to follow-up treatment was 2 months. Over 30% of patients experienced more than two seizures before commencing treatment, but this did not affect subsequent outcomes.

查看原文本刊更多论文

中年癫痫的特征和治疗：一项为期 24 年的单中心回顾性研究。

研究目的本研究旨在分析中国单个中心中年癫痫的临床特点、病因和治疗方法：方法：回顾性分析1999年2月至2023年3月在中国人民解放军总医院第一医学中心神经内科癫痫门诊就诊患者的临床资料。分析了过去24年中年癫痫的临床特征、病因和危险因素：在 969 名 45-64 岁发病的患者中，有 914 人被诊断为癫痫，且至少有两次无诱因癫痫发作相隔 24 小时。其中，99.7%（911 人）为局灶性癫痫。从首次癫痫发作到后续治疗的中位时间为 2 个月（四分位数间距 [IQR]：1.0-6.0 个月）。在开始治疗前，30.2%（207/683）的患者经历过两次以上的癫痫发作。66.3%的患者（606/914）找到了结构性病因。脑血管疾病（CVD）和脑外伤（TBI）分别占 19.9%（182/914）和 16.6%（152/914）。逻辑回归分析显示，影像学异常（几率比 [OR] 2.04；95% 置信区间 [CI]1.25-3.32；P = .004）、局灶性癫痫发作（OR 2.98；95%CI 1.82-4.87；P 意义重大：中年期发病的癫痫通常是局灶性病因，心血管疾病是最常见的病因，而且往往对药物治疗反应良好。从首次发作到后续治疗的中位持续时间为 2 个月。超过30%的患者在开始治疗前经历了两次以上的癫痫发作，但这并不影响后续治疗效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.