Early Predictors of Drug-Resistant Epilepsy Development after Convulsive Status Epilepticus

Abstract

Background: Drug-resistant epilepsy (DRE) is a common and serious consequence of convulsive status epilepticus (CSE). Little is known on the early prediction of DRE development after CSE. Our aim was to identify independent DRE predictors in patients with CSE. Methods: One hundred and forty consecutive patients identified with CSE in a tertiary academic hospital between March 2008 and January 2015 were reviewed. Demographics, clinical features, serum albumin neuroimaging, and electroencephalogram characteristics were collected and analyzed. Independent predictors of DRE were identified using multivariate logistic regression. The receiver operating characteristic (ROC) curve was used to quantify the predictive validity of all the risk factors. Results: After a median 62-month observation period, 91 patients were enrolled into this study. Thirty-seven (40.7%) patients did not have DRE, 22 (24.2%) developed DRE, and 32 (35.2%) were dead. History of epilepsy (OR 9.17, 95% CI 1.77–49.22, p = 0.010), status epilepticus duration ≥24 h (OR 4.82, 95% CI 1.04–22.37, p = 0.044), and cortical or hippocampal abnormalities on neuroimaging (OR 9.49, 95% CI 1.90–47.50, p = 0.006) were independent predictors of DRE after CSE. A combination of these 3 variables yielded an area under the ROC curve of 0.77 (0.65–0.89). Conclusions: History of epilepsy, longer SE duration, and cortical or hippocampal abnormalities on neuroimaging are early predictors for the development of DRE after CSE. Further studies are needed to assess whether a more aggressive treatment will reduce the likelihood of DRE development in these high-risk patients.

Predictors of Pharmaco-Resistance in Patients with Post-Stroke Epilepsy

“…At the same time, there is also ample evidence that modifications triggered by status epilepticus itself, such as BBB disruption, inflammation, angiogenesis, and reactive synaptogenesis, play an important role in the reorganization of neuronal networks and the progression of seizure activity [27,28]. The present findings reinforced the association between status epilepticus occurrence and seizure intractability that has been observed in few prior studies of epilepsy in children and adults [29][30][31][32].…”

Risk factors for drug-resistant epilepsy

“…[41] Wen et al reported that status epilepticus duration ≥24 hours was an independent predictor of DRE after convulsive status epilepticus. [42]…”

The relationship between magnesium and seizure control in epileptic patients

“…Our small number of samples may have led to this unique finding. [16][17][18] We found a significant relationship between the length of sun exposure and the frequency of seizures. Patient with epilepsy that was exposed to sunlight for more than 25 minutes for at least 3 days in a week experience 1-2 times lower seizures episodes per month than those who are less exposed.…”