Study On Risk Factors For Seizure Treatment Outcome Based On Cases Follow-Up Cohort

Epilepsy is a group of chronic brain disorders, which is caused by excessive discharge of brain cells. Epilepsy performance repeated relapsing neurologic symptoms. Seizure referred to the paroxysmal discharge of the brain neurons is clinical manifestation, and it can be perceived by patients and observers. Seizures bring heavy psychological and economic burden to patients and their families, and because of the lack of correct understanding on epilepsy, it brings to negative effect to patients and society in life, employment, and marriage.Antiepileptic drugs is the main method for the treatment of epilepsy, though there are three main methods:medical treatment (antiepileptic drugs)、surgical treatment、specific therapy (such as qigong therapy, etc.)We realized profoundly that there are significant differences in the AEDS efficacy and side effects in the long-term clinical practice. The blood drug concentration and curative effect is far among patients with the same diagnosis, using the same drug therapy. Some patients use the biggest tolerance, still can’t control seizures; And some patients with conventional quantity, will appear serious side effects of the drug.There are many factors on the individual differences, including genetic factors, clinical case characteristics, personal physiological factors and environmental factors, etc. The relationship and the influence between these factors lead to the complexity of the individual differences. Pharmacogenomics and drug genetics research results show that the genetic factors caused patients AEDS reaction is the individual differences of the most important reasons.However, in addition to the genetic factors (gene),clinical characteristics, personal physiological factors and environmental factors are also important factors to the prognosis of epileptic cure. Seizures and epilepsy syndrome type, tolerance and the safety of the drug, pharmacokinetics, clinical features, and the patient’s age, gender, whole body condition personal physiological characteristics and diet, smoking, alcohol and other environmental factors, have been clinical practice selection and use of the important basis of AEDS.The aims of present study are to explore the risk factors of seizure cure outcome using the RE-ZINB Statistical analysis method, which is based on cases follow-up cohort in hospital. Then the clustering analysis and principal component analysis of the method of combining, We summed up epilepsy type used to clinical drug, and finally evaluate epileptic cure effects of different drugs or drug combination of different subtypes prescription the prognosis of for further based on drug genomics research epilepsy personalized treatment plan provides the basis.Results:1. RE-ZINB regression analysis on multiple factors.(1). Risk factors on seizure outcome:①Habits and customs include smoke (RR=1.26),hunger.(RR=1.50)hunger.(RR=1.91);Daily alcoholcon (RR=2.97);②Poorer psychoplogical (RR=2.21、RR=1.66);③Risk factors of birth and history of Disease include birth trauma(RR=1.64), history of brain tumor(RR=1.56), history of craniocerebral injury(RR=1.76);④inducing factors of epileptic seizure include not medication according to the instruction(RR=1.55),scare(RR=1.44), Strong manual labor(RR=1.44), Nervous Excitement(RR=1.58), sleep-deprived (RR=1.39), Sleep epilepsy(RR=1.53), Excitant food (RR=1.93), influenza and fever(RR=1.59), endocrine alteration in puberties (RR=2.16).⑤Pointed wave tit-for-tat(RR=1.59).(2) Protective factors on seizure outcome①Age of initial epileptic seizure (0～10, RR=0.62;11～20, RR=0.64);②Normal delivery (RR=0.62);③Pharmacotherapy include Phenobarbital (RR=0.46), Oxcarbazepine (RR=0.40), VPA (RR=0.50), LTG (RR=0.55), LEV (RR=0.69), CBZ (RR=0.66), PHT (RR=0.55), Topamax (RR=0.52). medicine of Chinese traditional (RR=0.48) CBZ and LTG(RR=0.52).2、classification of epilepsy patients and the analysis of effect on drug therapy1. Generalized seizure classification and drug therapeutic effect of patients with epilepsy. Generalized seizures in patients are divided into five subtypes Based on clinical EEG features of epilepsy:①Generalized seizures slow-wave type;②Generalized seizures Sharp slow-wave③Generalized seizures Spike and wave type;④Generalized seizures (More) spike slow, sharp waves phenotype;⑤Generalized seizures Sharp slow, slow wave phenotypesThe drug prescription in accordance with the effect of treatment:①Generalized seizures slow-wave type:Lamotrigine, carbamazepine, phenytoin, LEV, sodium valproate+carbamazepine, phenobarbital,Chinese carbamazepine+phenytoin, Rameau triazine+carbamazepine;②Generalized seizures Sharp slow-wave: Carbamazepine.topiramatelamotrigine+carbamazepine, lamotrigine.phenobarbital+lamotrigine.phenytoin,sodiumoxcarbazepine,valproate+phenytoin RasiTan. phenobar bitone+sodium valproate, valproate+carbamazepine;③Generalized seizures Spike and wave type:Sodium valproate, lamotrigine, oxcarbazepine.2. Partial seizures classification and drug therapeutic effect of patients with epilepsy. Partial seizures in patients are divided into two subtypes Based on clinical EEG features of epilepsy:①Partial seizures Sharp slow spike and wave phenotype;②Partial seizures Sharp waves, slow-wave phenotype.the drug prescription in accordance with the effect of treatment:①Partial seizures Sharp slow spike and wave phenotype:Levetiracetam, phenytoin, oxcarbazepine.②Partial seizures Sharp waves, slow-wave phenotype:Lamotrigine,oxcarbazepine, carbamazepine+topiramat e.Conclusions:1Non-drug factors affecting the prognosis of epilepsy treatment is very complicated:1) the first onset age. the sooner, the better the prognosis of epilepsy is; 2) Smoking, drinking, often hunger on the adverse effects of treatment effect during the course of treatment,;3) imedication not obeyed by doctor, shock, intense physical labor, tension, excitement, lack of sleep, fatigue, sleep, epilepsy, sad depressing, stimulating feeding, fever, and adolescent endocrine changes in incentives are influencing factors affecting the therapeutic effect;)generalized seizures is better than partial seizures;5) psychological quality also affect the treatment effect of factors;6) history of febrile seizures, tumors, traumatic brain injury, family history, medical history of epilepsy prognosis;7) sharp wave detected against each other, the tip (spine) and slow wave, slow wave EEG variables affect the treatment of epilepsy.2Medication has an important role to control epileptic seizures, but the prescription efficacy is different. during prescription of a single agent, the efficacy in turn from good to bad is:topiramate, levetiracetam, valproate, Chinese medicine, oxcarbazepine, Rameau triazine, carbamazepine, phenytoin, phenobarbital combination of multi-drug prescriptions, there are only two treatment of epilepsy treatment is effective, efficacy:the combination of carbamazepine and phenytoin, valproate, and carbamazepine combination.3. Generalized seizure classification and drug therapeutic effect of patients with epilepsy. Generalized seizures in patients are divided into five subtypes Based on clinical EEG features of epilepsy:①Generalized seizures slow-wave type;②Generalized seizures Sharp slow-wave③Generalized seizures Spike and wave type;④Generalized seizures (More) spike slow, sharp waves phenotype;⑤Generalized seizures Sharp slow, slow wave phenotypes Partial seizures classification and drug therapeutic effect of patients with epilepsy. Partial seizures in patients are divided into two subtypes Based on clinical EEG features of epilepsy:the drug prescription in accordance with the effect of treatment:①Generalized seizures slow-wave type:Lamotrigine, carbamazepine, phenytoin, left LEV, sodium valproate+carbamazepine, phenobarbital,Chinesemedicine,carbamazepine+phenytoi n, Rameau triazine+carbamazepine;②Generalized seizures Sharp slow-wave: Carbamazepine,topiramate,lamotrigine+carbamazepine, lamotrigine,phenobarbital+ lamotrigine,phenytoin,sodiumvalproate+phenytoin,oxcarbazepine,RasiTan, phenoba rbitone+sodium valproate, valproate+carbamazepine;③Generalized seizures Spike and wave type:Sodium valproate, lamotrigine, oxcarbazepine.①Partial seizures Sharp slow spike and wave phenotype;②Partial seizures Sharp waves, slow-wave phenotype.the drug prescription in accordance with the effect of treatment:①Partial seizures Sharp slow spike and wave phenotype: Levetiracetam,phenytoin, oxcarbazepine.②PartialseizuresSharpwaves, slow-wave phenotype:Lamotrigine,oxcarbazepine, carbam azepine+topiramate.Innovations:(1) Clarify possible factors affecting the prognosis of epilepsy:the starting age, smoking, drinking, frequent hunger, not ordered by your doctor, scared, strong physical labor, stress, excitement, lack of sleep, fatigue, sleep, epilepsy, sad depressing, irritating eating, a feverendocrine changes of puberty, history of febrile seizures, tumors, traumatic brain injury, family history, sharp waves against each other, the tip (spine) and wave, slow wave and other possible factors affecting the prognosis of epilepsy.(2) Prove that the medication has an important role in seizure control, but the prescription efficacy of different drugs, the combination of single prescription for more drugs prescription is more commonly used and effective.(3) Established a new method of treatment-oriented epilepsy classification, developed a treatment-oriented epilepsy sub-class of personalized medicine principlesDeficiencies:1.There are many biases on answering the questions because of the study based on the cohort. It is unavoidable for the some reasons.2.There are errors in the relationship between the seizure outcome and some causes, because of the influence of sample, which leads to the scarce in the aged.3.Due to the different influence of EEG from the different antiepileptic drugs, the relationship between the seizure outcome and EEG without the antiepileptic therapy is needed for further research. In addition, if permitted, the relationship between repeat EEG and seizure outcome is also needed.