什洛莫Shinnar,医学博士,布朗克斯,纽约;杰奎琳法国医学博士,纽约,纽约;丹维尔,医学博士David s .光泽,PA;撒母耳Wiebe医学博士,加拿大阿尔伯塔省卡尔加里
2015年5月,08年提交
我们感谢Sethi博士他的评论。这条指导原则确定的临床危险因素有证据和共识。[1]例如,前一个大脑侮辱增加癫痫复发的风险,这可能会包括他的大部分条款“静态脑病。”Other risk factors have been studied but are not significant predictors. Slowing on the EEG has not been shown to be predictive of seizure recurrence. [2] There are undoubtedly other factors, possibly even some that he proposes, that may also increase likelihood of recurrence but are not adequately studied. The data on treatment are fairly clear regardless of the clinical risk factors. Immediate antiepileptic drug (AED) treatment compared with delayed AED treatment after a first unprovoked seizure reduces the risk of a second seizure in the first 2 years but does not alter long-term outcome. [1,3-5] Overall long-term outcomes are good, with over 75% of patients attaining seizure freedom. [5] It is therefore a risk-benefit decision that is best made by the clinician and the patient. This guideline provides a framework for making these decisions on the basis of the available evidence while leaving the ultimate decision to the clinician and patient, where it belongs.
1。Gronseth GS Krumholz, Wiebe年代,et al .循证指南:管理一个无缘无故的第一个成人癫痫:报告指南开发小组委员会的美国神经病学学会和美国癫痫协会。首页首页神经学2015;84:1705 - 1713。
我们感谢Sethi博士他的评论。这条指导原则确定的临床危险因素有证据和共识。[1]例如,前一个大脑侮辱增加癫痫复发的风险,这可能会包括他的大部分条款“静态脑病。”Other risk factors have been studied but are not significant predictors. Slowing on the EEG has not been shown to be predictive of seizure recurrence. [2] There are undoubtedly other factors, possibly even some that he proposes, that may also increase likelihood of recurrence but are not adequately studied. The data on treatment are fairly clear regardless of the clinical risk factors. Immediate antiepileptic drug (AED) treatment compared with delayed AED treatment after a first unprovoked seizure reduces the risk of a second seizure in the first 2 years but does not alter long-term outcome. [1,3-5] Overall long-term outcomes are good, with over 75% of patients attaining seizure freedom. [5] It is therefore a risk-benefit decision that is best made by the clinician and the patient. This guideline provides a framework for making these decisions on the basis of the available evidence while leaving the ultimate decision to the clinician and patient, where it belongs.
1。Gronseth GS Krumholz, Wiebe年代,et al .循证指南:管理一个无缘无故的第一个成人癫痫:报告指南开发小组委员会的美国神经病学学会和美国癫痫协会。首页首页神经学2015;84:1705 - 1713。
2。Krumholz, Wiebe年代,Gronseth G,等。实践参数:评估成人前无诱因抽搐(一个基于证据的审查):质量标准委员会的报告,美国神经病学学会和美国癫痫协会。首页首页神经学2007;69:1996 - 2007。
3所示。首次发作试验集团(FIR.S.T。组)。随机临床试验在抗癫痫药物的疗效降低复发的风险后第一次无缘无故tonic-clonic扣押。首页神经学1993;43:478 - 483。
4所示。Musicco M, Behgi E,索拉里,Viani F;首次发作试验小组(第一组)。第一tonic-clonic癫痫治疗并不能提高癫痫的预后。首页神经学1997;49:991 - 998。
5。马森,雅各布,约翰逊,金正日L, C赌博,查德威克D;医学研究理事会研究小组。立即早期和延迟抗癫痫药物治疗癫痫和单一癫痫:随机对照试验。《柳叶刀》2005年;365:2007 - 2013。
披露的信息,请通过journal@neurology.org联系编辑部。首页