予後良好なてんかん

A STUDY OF SEIZURE-FREE EPILEPTICS

I．緒言

　てんかんの治療経過中に，抗けいれん剤の服用によつて，治療の初期から長期間発作が抑制される，いわゆる予後の良いてんかんがあることは以前から知られている。

　わが国でおこなわれた予後調査^{1,3,14,16,18）}によれば，発作が3年以上抑制されているものは，約20％であるという。さきに，著者^17）は初診時より5年後の予後調査をおこなつたが，そのうちの29％のものは3年以上発作がなかつた。また17％のものは5年以上発作がなく，抗けいれん剤の服用を中止していた。

A follow-up study of 105 epileptic patients who had been seizure-free for at least three years was made to determine the criteria for favorable prognosis of epilepsy.

Among 109 patients who first visited our clinic in 1966 had followed up for five years, 32 were included in the seizure-free group, 77 were selected as controls.

The Grand Mal type of generalized convulsion was the most prevalent (90%) in the seizure-free group. On the other hand psychomotor seizure type and combined type of seizure were fewer than those in the control group.

Age of onset, past history, family incidence of seizures and the length of time from onset of the disease of medication did not correlate with favor-able prognoses.

The patients with high frequency of seizures in-volved in the seizure-free group were fewer than those in the control group.

It was revealed that the EEG before medication had not been related to the prognoses of epilepsy. In the course of medication, the EEG abnormality had normalized 35 of 75 patients in the seizure-free group, but 7 of 34 patients in the control group. Neither background-activity nor paroxysmal pat-terns in the EEG had been related to the improve-ment of EEG.

Among 35 patients whose seizure were eventually suppressed, 12 showed the EEG improved before or concomitant with the suppression of seizure.

Of 136 patients who had a seizure-free period of at least three years or more, 22 have recurred sei-zures, which were of the Grand Mal type. Most causes of recurrence were withdrawal or diminution of anti-convulsants. The EEG and clinical symptoms were of no value in predicting recurrence.

Though we have a little knowledge of seizure control and recurrence, in order to avoid side effects of medication, it is important to determine the minimal dosage of drugs by careful and gradual diminution.