| Part1Influence of Different Timing of AntiepilepticDrugs Treatment on Relapse and Prognosis for NewlyDiagnosed Epilepsy[Objective] To explore the influence of immediate and deferred antiepileptic drugs(AEDs) treatment on the relapse and prognosis of newly diagnosed patients withepilepsy.[Method] Newly diagnosed epileptic patients seen for an outpatient visit in NanjingBrain Hospital Affiliated to Nanjing Medical University were collected prospectively.They were divided into immediate (seizures≤2) and deferred AEDs treatment group(seizures>2) according to seizures before treatment, and treated with antiepilepticdrugs reasonably. The patients were followed up for more than2years respectively.Indexes observed were time to first and second seizure relapse after treatment, seizurerecurrence rate during follow up, time to≥1-year remission, as well as≥1-yearremission rate during follow up between immediate and deferred groups.Kaplan-Meier survive statistics was used to analyze time to seizure relapse and toachieving≥1-year seizure free after treatment. We also observed and compared theirrecurrence and≥1-year seizure free rate in follow up.[Results] A total of200newly diagnosed epilepsy patients were prospectivelyenrolled, of whom29were excluded from analysis, mostly due to lost of follow up orpoor record of seizures. And the length of follow up was2-14years (median3years).Among the171patients analyzed,69(40.35%) were in immediate group while theother102(59.65%) in deferred group. The basic and clinic characteristics were equaland comparable between these two groups. Till the end of the follow up, there were108(63.16%) patients relapsed, and133(77.78%) achieved≥1-year seizure free. Time to first and second seizure in immediate group was longer significantly than thatin deferred group (Log-Rank test χ~2=5.10, P=0.02; Log-Rank test χ~2=8.62, P=0.00respectively). Between immediate and deferred group, the recurrence rate were17.39%vs33.33%(χ~2=5.32, P=0.02),26.09%vs45.10%(χ~2=6.35, P=0.01),37.68%vs61.76%(χ~2=3.85, P=0.05),49.28%vs61.76%(χ~2=2.62, P=0.11),53.62%vs69.61%(χ~2=4.52, P=0.03) in3,6,12,24months and the end of follow up.Accordingly, time to≥1-year seizure free in immediate group was shorter than that indeferred group, but there were no statistical significant difference (Log-Rank testχ~2=1.67, P=0.20). Till the end of the follow up,57(82.61%) patients achieved≥1-year seizure free in immediate group which was higher than that in deferred group(76,74.51%), but there were also no statistically different (χ~2=1.56，P=0.21).[Conclusion] Immediate AEDs treatment could reduce early recurrence rate, but notremote prognosis for newly diagnosed epileptic patients with a few of seizures(seizures≤2). Part2Prediction for Relapse and Prognosis of NewlyDiagnosed Epilepsy[Objective] To investigate clinical factors as potential predictors for relapse andprognosis of epilepsy based on prospective observational data in China.[Method] Newly diagnosed patients with one or more seizures seen for an outpatientvisit in Nanjing Brain Hospital Affiliated to Nanjing Medical University wererecruited and followed for at least2years. Univariate and multivariate analyses forrisk factors were performed using Cox proportional-hazards model.[Results]171newly diagnosed patients were recruited with a median age of19yearsold (range6-70years old). Univariate analysis for seizure recurrence showed: partialseizures (HR=2.31,95%CI1.53-3.48), multiple seizure types (HR=1.97,95%CI1.40-2.77),>1seizure monthly pretreatment (HR=2.94,95%CI1.99-4.35),epileptiform EEG abnormality pretreatment (HR=1.98,95%CI1.22-3.21),nonepileptiform EEG abnormality after treatment (HR=2.41,95%CI1.26-4.64) and≥3seizures before pretreatment (HR=1.59,95%CI1.06-2.38) were associated withrecurrence. Patients with multiple seizure types (HR=2.01,95%CI1.31-3.10),epileptiform EEG abnormality (HR=1.95,95%CI1.09-3.49) and>1seizure monthlybefore treatment (HR=2.74,95%CI1.69-4.51) were independent predictors forseizure recurrence after multivariate analysis. Univariate analysis for remissionshowed: partial seizures (HR=0.55,95%CI0.39-0.78), multiple seizure types(HR=0.62,95%CI0.41-0.93),>1seizure monthly pretreatment (HR=0.57,95%CI0.39-0.83), epileptiform EEG after treatment (HR=0.57,95%CI0.36-0.89), relapsewithin (HR=0.01,95%CI0.00-0.04) and number of seizure relapses during1year oftreatment (HR=0.99,95%CI0.98-1.00) were associated with remission. Relapsespecially in the first6-12months (HR=16.13,95%CI5.24-50) and epileptiform EEGwithin1year of treatment (HR=1.6,95%CI1.031~2.584) were independent predictors for remission after multivariate analysis.[Conclusion] Multiple seizure types, epileptiform EEG abnormality and>1seizuremonthly before treatment had higher seizure recurrence risk. The best model topredict remission contained: relapse and epileptiform EEG within1year of treatment. Part3Influence of Different Tactics of AntiepilepticDrugs Withdrawal on Relapse for People with Epilepsy inSeizure Free[Objective] To explore the influence of different tactics (including early versus lateand normal versus slow) antiepileptic drugs (AEDs) withdrawal for people withepilepsy in seizure free.[Method] Patients with epilepsy in more than2seizure free years seen for anoutpatient visit in Nanjing Brain Hospital Affiliated to Nanjing Medical Universitywere collected and followed-up prospectively until relapse occurred or at least for2years. They were divided into early (2to3seizure free years) and late AEDswithdrawal group more than3seizure free years) according to the timing of AEDswithdrawal. Meanwhile, they were divided into normal (taper period of six months)and slow AEDs withdrawal group (taper period of more than six months) accordingto the rate of AEDs withdrawal. Indexes observed were time to first seizure relapseafter AEDs withdrawal, seizure recurrence rate during follow up between early versuslate and normal versus slow AEDs withdrawal groups. Kaplan-Meier survivestatistics was used to analyze the time to seizure relapse after AEDs withdrawal. Wealso observed and compared their cumulative recurrence rate in follow up.[Results] A total of90epileptic patients who have been seizure-free for more than2years were prospectively enrolled in the study, of which4were excluded fromanalysis, mostly due to loss of follow-up or incomplete record of seizures. Among the86patients analyzed,44(51.16%) were in early group and42(48.84%) in late group,the basic and clinic characteristics were equal and comparable between these twogroups;48(55.81%) in normal group and38(44.19%) in slow group, the basic andclinic characteristics were also equal and comparable between these two groups. And they were followed up for an average of2.1(±1.5) years. Till the end of the follow up,43of76(50.00%) patients relapsed. There were no statistically different for time toseizure relapse between early or late withdrawal groups (Log-Rank test χ~2=0.13，P=0.72) during follow up. The recurrence rate were11.36%vs9.52%(χ~2=0.08,P=0.78),29.55%vs14.29%(χ~2=2.91, P=0.09),38.64%vs40.48%(χ~2=0.03, P=1.86),45.45%vs52.38%(χ~2=0.41, P=0.52),47.73%vs52.38%(χ~2=0.19, P=0.67) in3,6,12and24months and the end of follow up between these two groups respectively.Accordingly, There were no statistically different for time to seizure relapse betweennormal or slow withdrawal groups (Log-Rank test χ~2=0.36，P=0.55). The recurrencerate were12.50%vs7.89%(χ~2=0.49, P=0.48),29.17%vs13.16%(χ~2=3.16, P=0.08),41.67%vs36.84%(χ~2=0.21，P=0.65),50.00%vs47.37%(χ~2=0.06, P=0.81),52.08%vs47.37%(χ~2=0.19, P=0.66) in3,6,12and24months of follow up between thesetwo groups respectively.[Conclusion] AEDs withdrawal could be considered for patients with≥2seizure freeyears. The risk of seizure recurrence during and after AEDs withdrawal in people freeof seizure for≥2years is not different whether the medications are tapered over asix-month period or less. Part4Prediction for Relapse after Antiepileptic DrugsWithdrawal in Seizure Free Patients with Epilepsy[Objective] To evaluate clinical factors as potential predictors for seizure relapseafter antiepileptic drugs (AEDs) withdrawal in epilepsy patients.[Method] Patients who were seizure-free for more than2years een for an outpatientvisit in Nanjing Brain Hospital Affiliated to Nanjing Medical University wererecruited and were followed prospectively for at least2years or until seizure relapse.AED was discontinued gradually over a period of6months for most patients, exceptsome low dose taken. Kaplan-Meier survival analysis was used for calculatingrecurrence rates. Univariate and multivariate analyses for recurrence risk factors wereperformed using Cox proportional-hazards model.[Results] Totally86epileptic patients with6-67years old (median age19years old)were recruited. And they were followed up for an average of2.1(±1.5) years.Epileptiform EEG abnormality during AEDs withdrawal (HR=2.78,95%CI1.19-6.49), epileptiform EEG abnormality within the first year after AEDswithdrawal (HR=4.71,95%CI2.24-9.89) and polytherapy (HR=2.83,95%CI1.00-8.02) were associated with seizure relapse, showed by univariate analysis.Epileptiform EEG abnormality within the first year after AED withdrawal (HR=4.81,95%CI2.22-10.42) was found as an independent predictor of seizure recurrence bymultivariate analysis.[Conclusion] Patients with epileptiform EEG abnormality within the first year afterAED withdrawal had higher seizure recurrence risks, and it is necessary to performEEG scan for those patients during their first year after AEDs withdrawal. |
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