婴幼儿自发性症状性癎性发作5年复发率的影响因素

Risk factors for 5-year recurrence of spontaneous symptomatic epileptic seizures in infants and young children

摘要:

目的 调查婴幼儿自发性症状性癎性发作首次发作后的复发率及其复发的危险因素.方法 收集苏州儿童医院2009 年4 月至2011 年4 月首次自发性症状性癎性发作婴幼儿的临床资料.每1~3 个月随访一次,随访时间1~60 个月.采用Kaplan-Meier 乘积限法及Cox 比例风险模型计算自发性症状性癎性发作复发率并分析复发危险因素.结果 符合入选标准的首次自发性症状性癎性发作患儿共63 例,首次发作5 年后累积复发43 例,5 年累积复发率为69.4%.复发大多在首次发作后1 年内,占总复发数的86%.多因素Cox 比例风险模型分析提示,脑电图癎样放电是自发性症状性癎性发作复发的独立危险因素,风险函数比为5.349,95% 可信区间为2.375~12.048.结论 婴幼儿自发性症状性癎性发作首次发作后的复发率高;脑电图癎样放电为其复发的独立的高危因素,建议此类患儿进行抗癫癎治疗.

Abstract:

Objective To investigate the recurrence rate and risk factors of spontaneous symptomatic epileptic seizures after the first episode in infants and young children. Methods The clinical data of infants and young children who experienced the first episode of spontaneous symptomatic epileptic seizures between April 2009 and April 2011 in Suzhou Children's Hospital were collected. Follow-up visits were performed once every 1-3 months, and the followup time was 1-60 months. The Kaplan-Meier method and Cox proportional hazards model were applied to calculate the recurrence rate of spontaneous symptomatic epileptic seizures and analyze the risk factors for seizure recurrence. Results Sixty-three children experiencing a first episode of spontaneous symptomatic epileptic seizures were enrolled. Within 5 years after the first episode, 43 children experienced the recurrence of spontaneous symptomatic epileptic seizures, with a 5-year cumulative recurrence rate of 69.4%. Among all recurrent cases, 86% experienced recurrence within 1 year after the first episode. The multivariate analysis with the Cox proportional hazards model showed that epileptiform discharges on electroencephalography were the independent risk factor for recurrence of spontaneous symptomatic epileptic seizures (HR=5.349, 95%CI: 2.375-12.048). Conclusions The recurrence rate of spontaneous symptomatic epileptic seizures after the first episode is high in infants and young children. Epileptiform discharges on electroencephalography are the independent risk factor for the recurrence, and thus it is suggested to perform antiepileptic therapy for these children.