老年患者的第一次发作:需要治疗吗? 来自回顾性研究的证据
Louise Linka1,2, Benedikt Magnus1, Nabard Faiz1
1Department of Neurology, Epilepsy Center Hessen, University Hospital Marburg, Philipps-University Marburg, Baldingerstr., 35043, Marburg, Germany.
Neurological research and practice
|March 28, 2024
概括
抗发作药物 (ASM) 在60岁以上的老年患者中显著减少发作复发. 即使没有明确的EEG或神经成像发现,也观察到这种保护作用,这表明ASM对经历第一次的老年人有好处.
科学领域:
- 神经学 神经学
- 老年医学 老年医学
- 发病学 (Epileptology) 是一个专业的学科.
背景情况:
- 第一次未引起的发作有~40%的复发风险.
- 老年患者可能面临更高的复发风险,因为与年龄相关的大脑变化和并发症.
- 关于特别是在老年人群中发作复发的数据有限.
研究的目的:
- 分析60岁及以上患者在第一次发作后的发作复发率.
- 调查影响复发的因素,包括EEG,神经成像和抗发作药物 (ASM) 处方.
- 评估ASM在预防老年人发作复发中的有效性.
主要方法:
- 对304名年龄在60岁以上,首次发作患者 (2004-2017) 的回顾性分析.
- 使用了等级式考克斯回归建模.
- 研究了EEG,神经成像,年龄和ASM对复发的影响.
主要成果:
- 一年和两年的发作复发率分别为24.5%和34.4%.
- ASM被处方给87.8%的患者,通常没有明确的性发作发现.
- ASM显著降低了复发风险 (HR=0.47);EEG,神经成像和年龄没有显著影响复发.
结论:
- 在60岁以上的患者中,ASM显示出强大的保护作用,防止发作复发.
- 在老年患者中,ASM似乎有利于降低复发风险,无论EEG/神经成像发现如何.
- 复发和病变之间缺乏关联可能涉及诸如脑病变或缩之类的混因素.
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