摘要：

目的 观察伴海马硬化的颞叶癫痫（TLE-HS）对药物治疗的反应性，分析药物反应良好的良性伴海马硬化的颞叶癫痫的临床特点。方法 46 例颞叶癫痫患者经MRI 证实伴海马硬化，抗癫痫药物治疗至少随访2 年，超过发作周期无癫痫发作，与51 例对抗癫痫药物耐药的患者比较人口学资料、早期突发损伤因素、癫痫家族史、临床症状、发作间期脑电图样放电、海马硬化侧别、药物治疗方案等特征，并采用多因素前进法Logistic 回归分析筛选药物治疗反应良好的影响因素。结果 良性TLE-HS 组与对照组患者发病年龄（P = 0.041）、病程（P = 0.001）、热性惊厥史（P = 0.019）、癫痫发作频率（P = 0.001）和药物治疗方案（P = 0.000）差异有统计学意义，而性别、年龄、出生史异常、脑炎史、颅脑创伤史、癫痫家族史、癫痫持续状态、认知功能障碍、精神障碍，以及发作类型、先兆、是否存在发作间期和发作间期脑电图样放电、海马硬化侧别差异均无统计学意义（P > 0.05）；其中，热性惊厥史是药物治疗反应良好的危险因素（OR = 3.405，95%CI：1.080 ~ 10.737；P = 0.037），而低癫痫发作频率（OR = 0.275，95%CI：0.100 ~ 0.758；P = 0.013）和单药治疗（OR = 0.135，95%CI：0.049 ~ 0.373；P = 0.000）是药物治疗反应良好的保护因素。结论 良性伴海马硬化的颞叶癫痫多于青少年后期发病，发病初期癫痫发作频率低，较少伴热性惊厥史，单药治疗特别是卡马西平或奥卡西平疗效较好。

关键词: 癫痫, 颞叶, 海马, 硬化, 回归分析

Abstract:

Objective To observe the drug response of patients with benign temporal lobe epilepsy with hippocampal sclerosis (TLE-HS), and to summarize the clinical characteristics of patients with good drug response. Methods A total of 46 benign TLE-HS patients who were treated by anti-epileptic drugs (AEDs) and followed-up for at least 2 years with seizure-free periods longer than 12 months were enrolled in benign TLE-HS group and 51 AEDs-resistant patients were enrolled in control group. Demographic data, early sudden damage factor, family history of epilepsy, clinical symptoms, interictal EEG abnormality, side of hippocamal sclerosis and drug strategy were noted and compared between 2 groups. Multivariate forward Logistic regression was used to analyze the influencing factors of good drug response to TLE-HS. Results Age of onset (P = 0.041), duration (P = 0.001), history of febrile seizure (P = 0.019), initial seizure frequency (P = 0.001) and drug strategy (P = 0.000) were statistically different between 2 groups. Age, sex, perinatal injury, encephalitis, traumatic brain injury (TBI), family history of epilepsy, status epilepticus (SE), cognitive impairment, mental disturbance, seizure type, aura, interictal EEG abnormality and side of hippocamal sclerosis were not statistically different between 2 groups (P > 0.05, for all). History of febrile seizure was risk factor for benign TLE-HS (OR = 3.405, 95%CI: 1.080-10.737; P = 0.037), while low initial seizure frequency (OR = 0.275, 95% CI: 0.100-0.758; P = 0.013) and monotherapy (OR = 0.135, 95% CI: 0.049-0.373; P = 0.000) were protective factors for good drug response. Conclusions Benign TLE - HS often occurs in late adolescence. In the early stage, seizure frequency is low and the occurrence of febrile seizure is rare. Monotherapy of carbamazepine or oxcarbazepine may achieve good therapeutic effect.

Key words: Epilepsy, temporal lobe, Hippocampus, Sclerosis, Regression analysis