不同风险因素导致的首次无诱因癫痫发作后的复发风险：一项为期 10 年的前瞻性队列研究。

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research Pub Date : 2024-10-06 DOI:10.1016/j.eplepsyres.2024.107457

Xin-yu Chen , Feng-huang Zhou , Ge Tan , Deng Chen , Ling Liu

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引用次数: 0

摘要

目的采用单因素和多因素方法评估首次无诱因癫痫发作后的复发风险，并进一步分析与复发相关的潜在风险因素：在一项前瞻性队列研究中，从 2010 年 1 月至 2019 年 12 月共招募了 201 名经历过首次无诱因癫痫发作的患者。通过卡普兰-梅耶生存曲线计算累计复发率。利用 Cox 回归模型对复发风险进行了多变量分析。此外，还通过量化交互作用（AP）导致的可归因比例来评估交互作用效应：结果：累积复发率如下：结果：累积复发率如下：6 个月时为 29.4%，1 年时 35.8%，2 年时 41.1%，5 年时 47.9%，10 年时 57.5%。值得注意的是，大多数复发（61.2%）发生在发病后的最初 6 个月内，74.4%发生在第一年内，82.6%发生在最初两年内。VEEG显示有癫痫异常放电、夜间发作、核磁共振成像异常、脑损伤和局灶性发作的患者的复发风险分别为71.9%、61.4%、61.5%、75.0%和69.7%。癫痫样放电（RR 2.5，95 % CI 1.4-4.3，P=0.001）和既往脑损伤（RR 2.1，95 % CI 1.2-3.7，P=0.007）是复发的预测因素。交互分析显示，痫样放电和先前脑损伤的组合与复发风险增加 7 倍相关（RR 7.0，95 %CI 3.5-14.2），AP 估计为 0.34，痫样放电和夜间发作的组合与复发风险增加 4 倍相关（RR 4.3，95%CI为2.4-7.4），AP估计为-0.25；既往脑损伤和夜间癫痫发作的组合与复发风险增加4倍相关（RR为4.1，95%CI为1.9-8.9），AP估计为-0.03：有癫痫样放电 VEEG、夜间癫痫发作、核磁共振成像结果异常、既往脑损伤或局灶性癫痫发作的患者复发率很高。具体而言，VEEG 记录中出现痫样放电和既往脑损伤史被确定为与初次无诱因癫痫发作后复发相关的独立风险因素。值得注意的是，与没有或只有一个风险因素的人相比，有多个风险因素的人复发风险明显更高。

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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Risk of recurrence after a first unprovoked seizure with different risk factors: A 10-year prospective cohort study

Objective

To evaluate the recurrence risk following a first unprovoked seizure using both single-factor and multiple-factor approaches, as well as to further analyze the potential risk factors associated with recurrence.

Methods

In a prospective cohort study, a total of 201 individuals who experienced their initial unprovoked seizure were recruited from January 2010 to December 2019. The cumulative recurrence rates were calculated by Kaplan–Meier survival curves. Multivariate analyses for recurrence risk were conducted utilizing the Cox regression model. Additionally, interaction effects were evaluated by quantifying the attributable proportion due to interaction (AP).

Results

The cumulative recurrence rates were as follows: 29.4 % at 6 months, 35.8 % at 1 year, 41.1 % at 2 years, 47.9 % at 5 years, and 57.5 % at 10 years. Notably, the majority of recurrences, specifically 61.2 %, manifested within the initial 6 months following the onset, with 74.4 % occurring within the first year, and 82.6 % within the initial 2 years. The recurrence risk of patients with epileptic abnormal discharges on VEEG, nocturnal seizure, abnormal MRI, prior brain insult and focal seizure was 71.9 %, 61.4 %, 61.5 %, 75.0 %, and 69.7 %, respectively. Epileptiform discharges (RR 2.5, 95 % CI 1.4–4.3, P=0.001) and prior brain insult (RR 2.1, 95 % CI 1.2–3.7, P=0.007) were predictors of recurrence. Interaction analysis showed the combination of epileptiform discharges and prior brain insult was associated with a 7-fold increased risk of recurrence (RR 7.0, 95 %CI 3.5–14.2)，with AP estimated at 0.34, the combination of epileptiform discharges and nocturnal seizure was associated with a 4-fold increased risk of recurrence(RR 4.3, 95 %CI 2.4–7.4), with AP estimated at −0.25,and the combination of prior brain insult and nocturnal seizures was associated with a 4-fold increased risk of recurrence(RR 4.1, 95 %CI 1.9–8.9), with AP estimated at −0.03.

Conclusions

Patients with epileptiform discharges VEEG, nocturnal seizures, abnormal MRI findings, prior brain insult, or focal seizures exhibited a substantial recurrence rate. Specifically, the presence of epileptiform discharges in VEEG recordings, and a history of prior brain insult were identified as independent risk factors associated with recurrence following an initial unprovoked seizure. Notably, individuals with multiple risk factors exhibited a significantly higher recurrence risk compared to those with no or a single risk factor.

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来源期刊

Epilepsy Research 医学-临床神经学

CiteScore

0.10

自引率

4.50%

发文量

143

审稿时长

62 days

期刊介绍： Epilepsy Research provides for publication of high quality articles in both basic and clinical epilepsy research, with a special emphasis on translational research that ultimately relates to epilepsy as a human condition. The journal is intended to provide a forum for reporting the best and most rigorous epilepsy research from all disciplines ranging from biophysics and molecular biology to epidemiological and psychosocial research. As such the journal will publish original papers relevant to epilepsy from any scientific discipline and also studies of a multidisciplinary nature. Clinical and experimental research papers adopting fresh conceptual approaches to the study of epilepsy and its treatment are encouraged. The overriding criteria for publication are novelty, significant clinical or experimental relevance, and interest to a multidisciplinary audience in the broad arena of epilepsy. Review articles focused on any topic of epilepsy research will also be considered, but only if they present an exceptionally clear synthesis of current knowledge and future directions of a research area, based on a critical assessment of the available data or on hypotheses that are likely to stimulate more critical thinking and further advances in an area of epilepsy research.