左乙拉西坦单药治疗癫痫患者的预后效果及 影响因素分析

Analysis of the Prognostic Outcomes and Influencing Factors of Levetiracetam Monotherapy in Patients with Epilepsy

摘要: 目的：探讨左乙拉西坦单药治疗癫痫患者的临床预后效果，并系统分析导致治疗耐药的独立危险因素，为临床个体化治疗方案的制定提供循证医学依据。方法：回顾性收集2022年1月至2024年12月于青岛大学附属医院神经内科门诊确诊为癫痫并接受左乙拉西坦作为单一药物治疗的614例患者的人口学资料、临床资料及影像学资料等特征并对患者的预后效果及影响因素进行分析。结果：本研究共纳入614例新诊断为局灶性癫痫并接受左乙拉西坦单药治疗的患者，其中对左乙拉西坦单药治疗敏感的患者有358例(58.3%)，耐药的患者有256例(41.7%)。单因素分析结果显示，癫痫家族史、推测病因、发病年龄、病程、发作频率、合并智力障碍、合并精神心理障碍、脑电图结果及头颅MRI结果与左乙拉西坦单药治疗耐药性显著相关(P < 0.05)，性别与耐药性无显著相关性(P > 0.05)。多因素Logistic回归分析结果显示，发病年龄 < 18岁、发病年龄 ≥ 40岁、病程 ≥ 5年、结构性病因、发作频率极频繁、合并智力障碍、脑电图显示癫痫样放电及头颅MRI存在致痫性结构性病变是导致左乙拉西坦单药治疗耐药的独立危险因素。结论：左乙拉西坦单药治疗癫痫患者的总体有效率为58.3%，仍有超过四成的患者出现治疗耐药。发病年龄呈“U型”分布特征(<18岁或≥40岁耐药风险升高)、病程长、结构性病因、发作频率极高、合并智力障碍、脑电图癫痫样放电及头颅MRI致痫性结构性病变是左乙拉西坦单药治疗耐药的独立危险因素。临床医生应根据这些危险因素对患者进行早期风险分层，制定个体化治疗策略，以提高治疗成功率。

Abstract: Objective: To investigate the clinical outcomes of monotherapy with levetiracetam in patients with epilepsy and to systematically analyze the independent risk factors associated with treatment resistance, thereby providing evidence-based medical grounds for the formulation of personalized clinical treatment plans. Methods: A retrospective study was conducted to collect demographic, clinical and imaging data from 614 patients diagnosed with epilepsy at the Outpatient Department of Neurology, The Affiliated Hospital of Qingdao University, between January 2022 and December 2024, who received levetiracetam as monotherapy. The clinical outcomes and influencing factors were analyzed. Results: This study included 614 patients newly diagnosed with focal epilepsy and receiving monotherapy with levetiracetam. Among them, 358 patients (58.3%) were responsive to levetiracetam monotherapy, whilst 256 patients (41.7%) were resistant. Univariate analysis revealed that a family history of epilepsy, presumed etiology, age at onset, duration of illness, seizure frequency, co-existing intellectual disability, co-existing psychiatric or psychological disorders, EEG findings, and cranial MRI findings were significantly associated with resistance to monotherapy with levetiracetam (P < 0.05); gender was not significantly associated with resistance (P > 0.05). Multivariate Logistic regression analysis revealed that age at onset < 18 years, age at onset ≥ 40 years, disease duration ≥ 5 years, structural etiology, very frequent seizure frequency, co-existing intellectual disability, EEG showing epileptiform discharges, and the presence of epileptogenic structural lesions on cranial MRI were independent risk factors for resistance to monotherapy with levetiracetam. Conclusion: The overall response rate to levetiracetam monotherapy in patients with epilepsy was 58.3%, with more than 40% of patients still developing treatment resistance. A “U-shaped” distribution of age at onset (with increased risk of resistance in patients aged <18 or ≥40 years), long duration of illness, structural etiology, extremely high seizure frequency, co-existing intellectual disability, epileptiform discharges on EEG, and epileptogenic structural lesions on cranial MRI are independent risk factors for resistance to monotherapy with levetiracetam. Clinicians should use these risk factors to perform early risk stratification of patients and develop individualized treatment strategies to improve treatment success rates.