1㫽ྲྀ⮫ᗋ⛉Ꮫ 12(1), 1-13, 2020

㫽ྲྀ་⒪ࢭࣥࢱ࣮࡚ࢇ࠿ࢇእ᮶ࡢ⌧ἣ̿ ➨2ሗ ̿㰻⸨₶ ᡣᏳᜨ⨾ ໭ᕝ㐩ஓ ᳜⏣ಇᖾ ୗ⏣ගኴ㑻 ⏣㈡ᰤஅ ⏣୰ឡᅵᒃ඘ 㔠⸨኱୕ ᑠすྜྷ⿱ 㧗ᶫᾈኈ ஭ୖ୍ᙪᅜ❧⑓㝔ᶵᵓ㫽ྲྀ་⒪ࢭࣥࢱ࣮⬻⚄⤒ෆ⛉The current status of epilepsy outpatient clinic of Tottori Medical Center― follow-up report―
Jun Saito, Emi Fusayasu, Tatsuya Kitagawa, Toshiyuki Ueta, Kotaro Shimoda, Hideyuki Taga, Ai Tanaka,Mitsuru Doi, Daizo Kaneto, Yoshihiro Konishi, Hiroshi Takahashi, Kazuhiko Inoue
Department of Neurology and Psychiatry, NHO Tottori Medical Centerせ᪨2012 ࠿ࡽ 2019 ᖺᗘ㸦2012 ᖺ 4 ᭶࠿ࡽ 2020 ᖺ 3 ᭶ࡲ࡛㸧ࡢ 8 ᖺ㛫࡟㫽ྲྀ་⒪ࢭࣥࢱ࣮࡚ࢇ࠿ࢇእ᮶
ࢆึデࡋࡓᝈ⪅ࡣ 150 ྡ࡛࠶ࡾ, ࡇࡢ࠺ࡕ 128 ྡࡀ࡚ࢇ࠿ࢇ࡜デ᩿ࡉࢀ, 22 ྡࡀ࡚ࢇ࠿ࢇ࡛࡞࠸࡜デ᩿
ࡉࢀࡓ. ࡚ࢇ࠿ࢇ࡜デ᩿ࡉࢀࡓ 128 ྡ࡜, ࡑࡢ࠺ࡕ 2019 ᖺᗘᮎ㸦2020 ᖺ 3 ᭶᫬Ⅼ㸧࡟㏻㝔ࢆ⥅⥆ࡋ࡚࠸ࡓ 73 ྡ࡟ࡘ࠸࡚, Ⓨ⑕᫬࣭ึデ᫬ᖺ㱋, デ᩿, ⸆≀἞⒪, Ⓨసࢥࣥࢺ࣮ࣟࣝ≧ἣ࡞࡝࡟ࡘ࠸᳨࡚ウࡋࡓ.
࡚ࢇ࠿ࢇ඲౛ 128 ྡ࡛ࡣ, ࡯࡜ࢇ࡝ࡀ 10 ௦ࡲ࡛࡟ึⓎࡋ࡚࠸ࡓࡀ, 60%௨ୖࡢᝈ⪅࡛ࡣึⓎ࠿ࡽᙜ㝔ཷデࡲ࡛ࡢᮇ㛫ࡀ 10 ᖺࢆ㉸࠼࡚࠸ࡓ. ࡲࡓ, ඲⯡Ⓨస, ≉Ⓨᛶ඲⯡࡚ࢇ࠿ࢇࡢẚ⋡ࡀ, ⴭ⪅ࡽࡢ๓ᅇࡢ
ሗ࿌ࡼࡾࡶቑຍࡋ࡚࠸ࡓ. 8 ᖺࡢㄪᰝᮇ㛫ࢆ 4 ᖺࡎࡘ๓༙࣭ᚋ༙࡟ศࡅࡿ࡜, ึデ᫬ࡢ᪂つᢠ࡚ࢇ࠿ࢇ⸆౑⏝㢖ᗘࡣ, ๓༙ࡼࡾࡶᚋ༙࡛ቑຍࡋ࡚࠸ࡓ.
㏻㝔⥅⥆୰ࡢ 73 ྡ࡛ࡣ, Ⓨ⑕᫬ᖺ㱋ࡣ 10 ௦ࡲ࡛ࡀ኱ከᩘࢆ༨ࡵ, ᙜእ᮶ཷデࡲ࡛࡟ 20 ᖺ௨ୖࢆ⤒㐣ࡋ࡚࠸ࡿࡶࡢࡀከ࠿ࡗࡓ. ⣙༙ᩘࡀᑠඣ⛉ࡼࡾࡢ⛣⾜ᮇ་⒪, ḟ࠸࡛๓་ࡢ㏥⫋, ㌿ᒃ, ᑓ㛛ⓗ἞⒪ᕼᮃ࡛࠶ࡗࡓ. 1981 ᖺࡢ ILAE ࡢⓎసศ㢮࡛ࡣ, ඲⯡Ⓨస 16 ྡ, 㒊ศⓎస 53 ྡ, ᮍศ㢮࡚ࢇ࠿ࢇⓎస 4ྡ࡛࠶ࡾ, 1989 ࡢᖺ ILAE ࡢ࡚ࢇ࠿ࢇ࣭࡚ࢇ࠿ࢇ⑕ೃ⩌ศ㢮࡛ࡣ, ≉Ⓨᛶ඲⯡࡚ࢇ࠿ࢇ࠾ࡼࡧ⑕ೃ⩌ 15ྡ, ₯ᅉᛶ඲⯡࡚ࢇ࠿ࢇ࠾ࡼࡧ⑕ೃ⩌ 2 ྡ, ⑕ೃᛶᒁᅾ㛵㐃ᛶ࡚ࢇ࠿ࢇ࠾ࡼࡧ⑕ೃ⩌ 51 ྡ, ↔Ⅼᛶ࠿඲⯡ᛶ࠿Ỵᐃ࡛ࡁ࡞࠸࡚ࢇ࠿ࢇ࠾ࡼࡧ⑕ೃ⩌ 5 ྡ࡛࠶ࡗࡓ. ౑⏝ᢠ࡚ࢇ࠿ࢇ⸆ᩘࡣ, ึデ᫬࡟ࡣ 9 ྡࡀᮍ἞⒪, 1 ๣ 31 ྡ, 2 ๣ 23 ྡ, 3 ๣ 5 ྡ, 4 ๣ 2 ྡ, 5 ๣ 3 ྡ࡛࠶ࡗࡓ. ࡇࢀࡀ 2019 ᖺᗘᮎ࡛ࡣ, 1 ๣ 28 ྡ, 2๣ 30 ྡ, 3 ๣ 11 ྡ, 4 ๣ 1 ྡ, 5 ๣ 3 ྡ࡜࡞ࡗ࡚࠸ࡓ. ึデ᫬ᮍ἞⒪ 9 ྡ࡟ࡘ࠸࡚ࡣ, 2019 ᖺᗘᮎࡣ 1 ๣ 4ྡ, 2 ๣ 4 ྡ, 3 ๣ 1 ྡ࡛࠶ࡗࡓ. 2019 ᖺᗘᮎ࡟➨୍㑅ᢥ⸆ࡢࣂࣝࣉࣟ㓟㸦VPA㸧ࢆ᭹⸆୰ࡢᝈ⪅ࡣῶᑡࡋ,᪂つᢠ࡚ࢇ࠿ࢇ⸆ࡢࣛࣔࢺࣜࢠࣥ㸦LTG㸧, ࣞ࣋ࢳࣛࢭࢱ࣒㸦LEV㸧, ࣛࢥࢧ࣑ࢻ㸦LCM㸧ࢆ᭹⸆୰ࡢᝈ⪅ᩘࡣቑ࠼ࡓ. ⏝㔞ࡣ LTG ࡛ቑຍࡋ࡚࠸ࡓ. Ⓨస㢖ᗘ࡛ࡣ, ึデ᫬ࡼࡾࡶ 2019 ᖺᗘᮎࡢ࡯࠺ࡀࢥࣥࢺ࣮ࣟࣝⰋዲࡢேࡀቑ࠼ࡓ. 㫽ྲྀ⮫ᗋ⛉Ꮫ 12(1), 1-13, 2020
AbstractA total of 150 patients received an initial treatment at the epilepsy outpatient clinic of Tottori Medical Center
between April 2012 and March 2020, and 128 patients were diagnosed as epilepsy, while 22 patients were diagnosed
as a disease other than epilepsy. Among the 128 patients diagnosed as epilepsy, 73 patients who continued to receive
outpatient care at the end of the fiscal year 2019; that is, March 2020, were included in the present study. We1

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investigated their age at the time of epilepsy onset and the initial treatment, diagnosis, the presence or absence ofdrug treatment, and seizure management status.
The majority of the 128 patients initially experienced epilepsy before turning 20. Time from the initial
experience to receiving the first treatment at our hospital was 10 years or longer in more than 60% patients. The
percentage of generalized seizure and idiopathic generalized epilepsy increased compared with that of our previous
report. The 8-year investigation period was divided in to the first and second half (i.e., the first 4 years and second
4 years) to compare the frequency of antiepileptic drug prescription at the initial treatment. The result showed thatthe use of such drugs was more frequent in the second 4 years than in the first 4 years.
The majority of the 73 patients who continued to receive follow-up care at the hospital developed the initial
epilepsy before their 20s. In many, the interval between their first experience of epilepsy and receiving first treatment
at our hospital exceeded 20 years. The most common reasons leading to undergoing treatment at our hospital were
graduating out of pediatric care (approximately half of the patients), retirement of the previous physician, move toanother city, and request for specialized treatment.
According to the seizure classification created by the International League Against Epilepsy (ILAE) in 1981, 16patients had generalized seizures, 53 patients had partial seizures, and 4 patients had unclassified epileptic seizures.
According to the epilepsy/epilepsy syndrome classification established by ILAE in 1989, 15 patients had idiopathic
generalized epilepsy and epilepsy syndromes, 2 patients had cryptogenic generalized epilepsy and epilepsy
syndromes, 51 patients had symptomatic localization–related epilepsy and epilepsy syndromes, and 5 patients had
undetermined focal or generalized epilepsy and epilepsy syndromes. The number of antiepileptic drugs used at theinitial treatment was as follows: no treatment (9 patients), 1 drug (31 patients), 2 drugs (23 patients), 3 drugs (5patients), 4 drugs (2 patients), and 5 drugs (3 patients). These values changed to 1 drug (28 patients), 2 drugs (30patients), 3 drugs (11 patients), 4 drugs (1 patient), and 5 drugs (3 patients) in March 2020. In addition, 9 patients
who were untreated at the initial visit received these drugs in March 2020: 1 drug (4 patients), 2 drugs (4 patients),
and 3 drugs (1 patient).
The number of patients who used valproate (VPA), a first-line drug for epilepsy, decreased, while that of patients
who took lamotrigine (LTG), levetiracetam (LEV), and lacosamide (LCM), which are new antiepileptic drugs,
increased in March 2020. The dose of LTG increased. The percentage of patients who can manage their seizures
was higher in March 2020 than at the initial treatment. Tottori J. Clin. Res. 12(1), 1-13, 2020
Key words: ࡚ࢇ ࠿ࢇ , እ ᮶ , ⛣ ⾜ᮇ ་⒪ , ᆅ ᇦ㐃 ᦠ , ᢠ ࡚ࢇ ࠿ࢇ ⸆ , Ⓨస ࢥ ࣥࢺ ࣮ࣟ ࣝ ; epilepsy,outpatient clinic, transition medicine, regional cooperation, antiepileptic drugs, seizure managementࡣࡌࡵ࡟ࡋ࡚ 2014 ᖺ࡟ᨵゞࡉࢀࡓ 2). ࡲࡓ, ᪂ࡓ࡞࡚ࢇ࠿㫽ྲྀ་⒪ࢭࣥࢱ࣮㸦௨ᚋᙜ㝔࡜␎㸧⚄⤒ෆ⛉ࢇⓎసᆺศ㢮ࡀ 2017 ᖺ࡟Ⓨ⾲ࡉࢀࡓ 3). ࡉࡽ࡟,㸦2019 ᖺ 4 ᭶ࡼࡾ⬻⚄⤒ෆ⛉㸧࡛ࡣ, 㛤タࡉࢀ࡚ࢃࡀᅜ࡛ࡣ࡚ࢇ࠿ࢇデ⒪࢞࢖ࢻࣛ࢖ࣥ 4) ࡀ 2018

௨㝆, 㫽ྲྀ┴ᮾ㒊࡟࠾ࡅࡿ㞴἞ᛶ࡚ࢇ࠿ࢇ἞⒪࡟ᖺ࡟ᨵゞࡉࢀࡓ. ࡇࡢ୰࡛᪂つᢠ࡚ࢇ࠿ࢇ⸆࡟ࡘᑾຊࡋ࡚ࡁࡓ. ⴭ⪅ࡽࡣ, 2013 ᖺ࡟ࠕ㫽ྲྀ་⒪ࢭ࠸࡚ࡢグ㍕ࡀ㏣ຍࡉࢀ, デ᩿, ᳨ᰝ, ἞⒪࠾ࡼࡧ

ࣥࢱ࣮࡟࠾ࡅࡿ࡚ࢇ࠿ࢇデ⒪࡜㫽ྲྀ┴ᮾ㒊࡛ࡢணᚋࡀ᭱᪂໬ࡉࢀࡓ. 1990 ᖺ௨㝆Ḣ⡿࡛⥆ࠎ࡜Ⓨᆅᇦ་⒪㐃ᦠࠖ࡜㢟ࡋ࡚, 2012 ᖺ࡛ࡢᙜ㝔⚄⤒኎ࡉࢀ࡚࠸ࡓ᪂つᢠ࡚ࢇ࠿ࢇ⸆ࡀ, ࢃࡀᅜ࡛ࡶෆ⛉࡟࠾ࡅࡿ࡚ࢇ࠿ࢇᝈ⪅ࡢእ᮶἞⒪≧ἣࢆሗ2006 ᖺ௨㝆౑⏝࡛ࡁࡿࡼ࠺࡟࡞ࡾ, ࡑࡢᚋࡢ⑕౛1)

࿌ࡋࡓ . ᙜ㝔࡛ࡣ 2012 ᖺ࡟࡚ࢇ࠿ࢇእ᮶ࢆ㛤タࡢ⵳✚࡟ࡼࡗ࡚࣓ࣜࢵࢺ࣭ࢹ࣓ࣜࢵࢺࡀ᫂☜࡟࡞ࡋ࡚࠿ࡽࡣ, 㫽ྲྀ┴ᮾ㒊ࡢ࡚ࢇ࠿ࢇ་⒪ࡢ஧ḟ་ࡗࡓ. ࡲࡓ, ௨๓ࡣᢠ࡚ࢇ࠿ࢇ⸆ࡢ༢๣἞⒪ࡀ᥎

⒪ࢆᢸࡗ࡚ࡁࡓ.

ዡࡉࢀ࡚࠸ࡓࡀ, ㏆ᖺࡣ㞴἞౛࡞࡝࡟ᑐࡋ࡚ྛ⸆๓ᅇࡢㄪᰝ 1) ᚋࡢ 8 ᖺ㛫࡟, ᅜ㝿ⓗ࡟ࡣ, ᅜ㝿๣ࡢస⏝ᶵᗎ࡞࡝ࢆ⪃៖ࡋࡓ͆ྜ⌮ⓗከ๣ే⏝⒪࡚ࢇ࠿ࢇ㐃┕㸦ILAE㸧࡟ࡼࡾ, ࡚ࢇ࠿ࢇ࡜࠸࠺⑌ἲ㸦rational polytherapy㸧͇5) ࡀዡࡵࡽࢀࡿࡼ࠺࡟࡞ᝈ⮬యࡢᐃ⩏ࡀࠕ࡚ࢇ࠿ࢇࡢᐇ⏝ⓗ⮫ᗋᐃ⩏ࠖ࡜ࡗࡓ. ࡇࡢࡓࡵ, ࡚ࢇ࠿ࢇ἞⒪་ࡣ, ྛ⸆๣ࡢ≉2