成人てんかん患者における予後予測に関する研究

A Study on the Prediction of Long-term Prognosis of Adulthood Epilepsy

　10〜20年間にわたって治療経過を観察し得た年齢18歳以上のてんかん患者141例について，抗てんかん薬治療開始後2年目までに明らかにされた臨床因子と長期予後との関係を検討した。てんかん類型についてみると，側頭葉てんかんに難治例が多かった。臨床因子別にみると，成人発症例，器質性脳病変や神経精神医学的合併障害を有する例の予後は不良であった。治療開始後2年間の初期治療効果を判定し，これと長期予後との関係をみたところ，両者の間には密接な相関が認められた。更に，数量化理論II類による判別分析を行い，以上の臨床因子と予後との関係を総合的に分析したところ，てんかんの予後判別（予測）に際して重要な要因は，①てんかん類型，②神経精神医学的合併障害の有無③発症年齢，④初期治療効果，⑤器質性脳病変の有無，⑥発症一治療開始期間の順で大きいことが示された。また，以上の各臨床因子から予後の良否を正しく予測できる確率は73％という結果であった。

We report results of a study on the relation between the clinical findings 2 years after initiation of the therapy and the long - term prognosis of seizure control, and discuss the possibility of predicting the prognosis in the early stage of ther-apy. The subjects consisted of 141 patients, obser-ved for 10 to 20 years at Hirosaki University Hospi-tal. Regarding the epilepsy type, the prognosis of temporal lobe epilepsy was unfavorable. In tempo-ral lobe epilepsy, only 21 % were in remission (seizure-free for 3 years or more) at the time of the study. Also, the presence of organic brain lesions or neuropsychiatric complications at the early stage of treatment was associated with unfavorable progno-sis. We are particularly interested in the possibility of predicting the long-term prognosis from theresult of early response to anti-epileptic drug ther-apy. We found a significant correlation between the early excellent response to drug treatment and the good long-term prognosis. Using discriminant analysis (quantification theory II) , we tried to find which factors would influence more to the long-term prognosis. As the result, an importance was found in the following order : (1) epilepsy type, (2) presence or absence of neuropsychiatric complica-tions, (3) age at onset, (4) early response to treat-ment, (5) presence or absence of organic brain lesions and (6) the interval between the onset and the initiation of drug treatment. Correct identification rate by discriminant analysis was 73 %.