소아 소발작간질에서 Valproate 치료반응의 예측인자에 대한 연구
Predictive Factors for Valproate Treatment in Childhood Absence Epilepsy
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목 적:소아소발작간질에서 VPA를 첫 항경련제로 사용 시에 장기 관해에 영향을 주는 임상적 및 인구학적 특징을 파악하기위해 연구를 시행하였다. 방 법:인제대학교 부산백병원 소아과에서 소아소발작간질로 진단받은 후 첫 치료제로 VPA를 투여받은 환아를 대상으로 열성경련의 과거력, 동반된 다른 경련형태, 치료 시작 전 하루 경련 횟수, 첫 증상 후 치료 지연 개월 수, VPA의 초기반응, VPA 비반응군에서는 약제의 중단이유, 나타났던 약물부작용 그리고 VPA 비반응군에서는 부가요법으로 사용한 항경련제를 조사하여 경련의 장기관해와의 상관성을 보기위해 분석을 시행하였다. 결 과:소발작간질환아중에서 VPA를 첫 치료제로 처방받은 환아는 39명이었다. 이 중 장기 관해에 이른 환아 수는 27명이었고 이들의 임상과 병력상의 변수를 분석하여 연관성을 갖는 경우를 분석해본 결과 다변수 회귀 분석을 하였을때 초기치료에 실패한 경우 유의하게 장기 관해의 실패 가능성이 높았다. VPA에 반응하지 않은 경우 LTG를 부가요법으로 사용한 군과 ESM을 부가요법으로 사용한 군 사이의 비교에서는 LTG을 추가한 군에서 장기적 경련 관해에 이른 경우가 의미 있게 많았다(P= 0.045). 그 밖에 성별, 진단 시의 나이, 진단 후 치료의 지연기간, 치료 전 하루 경련 횟수, 열성 경련의 과거력, 전신 강직간대발작의 동반 유무 등은 VPA로 치료 후 장기관해와의 연관성을 보이지는 않았다. 결 론:소발작간질 환아를 치료 시에 VPA에 초기반응이 없을 경우 장기적 관해의 실패를 예측할 수 있다.
Abstract
Purpose:To determine the clinical and demographic factors associated with long- term remission of valproate(VPA) therapy in childhood absence epilepsy. Methods:Fifty-six cases of childhood and juvenile absence epilepsy were identified by reviewing of Electroencephalographic records and medical charts. Thirty-six cases were initially treated with VPA. Factor associated with responsiveness were identified by uni- and mutivariate logistic regression. Results:Twenty-seven patient achieved long-term remission(75%). Failure to achieve remission was more likely if the initial treatment of VPA had failed than if it was successful(53% versus 90.4%, P<0.02) was also associated with failure of long-term remission. Lamotrigine was more efficacious add-on drug than Ethosuximide(63.6% vs 25% P=0.04). Conclusion:Long-term seizure remission was related to the patient's initial response to VPA.
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