The Series Research Of Early Aeds Therapy With Newly Diagnosed Epilepsy Patients

Part1 The efficacy and safety evaluation of newly and traditional antiepileptic drugs monotherapy in patients with newly diagnosed epilepsy.【Abstract】Objective To evaluate the efficacy and safety of newly and traditional antiepileptic drugs in treatment newly diagnosed epilepsy. Methods We collected 143 patients with newly diagnosed epilepsy who was treated with monotherapy. Carbamazepine (CBZ) is used for patients with partial seizure (n=30), sodium valproate (VPA) for generalised seizure (n=50), while topiramate (TPM, n=33) and lamotrigine (LTG, n=30) could be used for both of them. The clinic characteristics were observed prospectively. The patients were followed up for at least one year. Kaplan-Meier survive statistics was used to analysis time to first seizure and time to treatment failure (either to inadequate seizure control or to intolerable side-effects, or both) after treatment. Meanwhile 6-months or 1-year remission and drugs adverse events were also observed and compared. Results The time to first seizure (Log-Rank =5.94, P=0.115) and the time to treatment failure (Log-Rank=4.82, P=0.185) were no statistical significant difference between newly and traditional AEDs monotherapy with newly diagnosed epilepsy. The proportion of patients for 6-months remission in CBZ, VPA, TPM and LTG group was 80%, 78%, 87.9%, 63.3% respectively (χ~2=5.63, P=0.131);and that for 1-year remission was 70.0%, 66%, 66.7%, 50.0% respectively (χ~2=3.19, P=0.364). But both of them were no statistical significant difference between four groups. The proportion of adverse events in TPM group (63.3%) was higher than that in CBZ (20%), and VPA (24%) group (TPM vs CBZ:χ~2=12.22, P=0.001; TPM vs VPA:χ~2=13.04, P=0.001). The proportion of adverse events in LTG group was 16.7% that was no statistical significant difference compared with CBZ and VPA group (LTG vs CBZ:χ~2=0.08, P=1.000; LTG vs VPA:χ~2=1.21, P=0.575). Conclusions Efficacy and safety of newly AEDs were not superior to that of traditional AEDs for newly diagnosed epilepsy. TPM has more mild to moderate adverse events than CBZ and VPA.Part 2 Early predictors of the first drug effect for newly diagnosed epilepsy.【Abstract】Objective To explore factors which influence the patients therapeutic effect of first drug with newly diagnosed epilepsy. Methods We collected 155 patients with newly diagnosed epilepsy. The clinic characteristics were observed prospectively. Each patient was treated with monotherapy. The patients were followed up for at least one year. The end events were that time to first seizure and time to treatment failure after early treatment. The treatment failure include that stopping the drug due either to inadequate seizure control or to intolerable side-effects, or both. Univariate and multiple Cox regression analysis were used to predict the early clinic characteristics which influence the first drug efficacy of newly diagnosed epilepsy. Results Strong univariate associations were noted between time to first seizure after treatment and following factors: family history of epilepsy, abnormal epileptiform EEG, seizures before treatment. With multiple Cox regression analysis, independent predictors of time to first seizure after treatment were family history of epilepsy (HR=2.39, 95%CI: 1.07-5.31), abnormal epileptiform EEG (HR=2.05, 95%CI: 1.30-3.21), seizures before treatment (HR=1.76, 95%CI: 1.05-2.95). Strong univariate associations were noted between time to treatment failure aft er treatment and following factors: female patients, abnormal epileptiform EEG. With multiple Cox regression analysis, independent predictors of time to treatment failure after treatment were female patients (HR=4.25, 95%CI: 2.01-9.00), partial seizures(HR=2.54, 95%CI: 1.25-5.16), abnormal epileptiform EEG (HR=3.11, 95%CI: 1.45-6.69). There were no associations between time to first seizure and to treatment failure after treatment and the following factors: the age at seizure onset, seizure at sleeping, the etiology of the seizures, brain injured during perinatal period, febrile seizures, remote brain injured, mental retardation at the early time, abnormal brain imaging, the time first seizure to treatment. Conclusions Patients with newly diagnosed epilepsy who are female and have abnormal epileptiform EEG, family history of epilepsy, seizures before treatment, partial seizures are likely to have poor outcomes after early treatment.Part 3 Influence of different treatment time on the prognosis of patients with newly diagnosed epilepsy.【Abstract】Objective To explore the influence of different treatment time on the prognosis of patients with newly diagnosed epilepsy. Methods We collected 155 patients with newly diagnosed epilepsy. The clinic characteristics were observed prospectively. Patients were divided into immediate (n=84, seizures≤3)or deferred antiepileptic drug treatment group (n=71, seizures>3)according to seizures before treatment. Each patient was treated with monotherapy reasonably. The patients were followed up at least for one year. Kaplan-Meier survive statistics was used to analysis time to first seizure or time to treatment failure (either to inadequate seizure control or to intolerable side-effects, or both) after early treatment. The proportion of patients with seizure free in follow up was also observed and compared. Results Time to first seizure or time to treatment failure was no statistical significant difference between immediate and deferred group (Log-Rank=0.571, P=0.450; Log-Rank=0.018, P= 0.893). The patients of treatment failure is 20 (23.8%) in immediate group and 16 (22.5%) in deferred group. There was also no statistical difference (χ~2 =0.035,P=0.852). The seizure free patients in the period of follow up is 40 (47.6%) in immediate group and 30 (42.3%) in deferred group. There was also no statistical difference (χ~2 =0.447,P=0.504). Conclusions For newly diagnosed epilepsy patients with a few of seizures (seizures≤3), immediate antiepileptic drug treatment dose not affect the prognosis.