Factors predicting prognosis of epilepsy after presentation with seizures

Abstract

The objective of this study was to identify the factors, at the time of diagnosis, that determine the prognosis for remission of epilepsy. A prospective community‐based cohort study of 792 patients recruited at the time of their first diagnosis of epileptic seizures was undertaken; in those classified 6 months after presentation, the median follow‐up period was 7.2 years (quartiles at 6.2 and 8.2 years) after presentation. We analyzed data from 6 months after the first identified seizure, which prompted the dianosis of epilepsy, to allow us to factor in those aspects contingent on a diagnostic assessment. Baseline clinical and demographic data were analyzed using the Cox proportional hazards regression model with remission of epilepsy for 1, 2, 3, and 5 years as outcome measures. The dominant clinical feature predicting remission was the number of seizures in the 6‐month diagnostic assessment period. Thus, the chance of entering 1 year of remission by 6 years for a patient who had 2 seizures during this initial 6 months was 95%; for 5 years of remission, it was 47% as opposed to 75% for 1 year of remission and 24% for 5 years of remission if there had been 10 or more seizures during this period. The number of seizures in the early phase of epilepsy (here, taken as the first 6 months after presentation) is the single most important predictive factor for both early and long‐term remission of seizures. Ann Neurol 2000;48:833–841

Is Refractory Epilepsy Preventable?

“…Combining several variables (the number of seizures, seizure type, etiology, failure to attain a 3-month remission during a 6-month period, and the EEG at 6 months), they correctly predicted a poor outcome in 66% of patients and a "not poor" outcome in 79% of patients (12). Similar variables have been used by others seeking to identify risk factors for medication resistance (52)(53)(54)(55). Finally, using the syndromic classification provides a better approach to predict intractability in childhood epilepsy, particularly in highly refractory epilepsies (see pediatric section, later).…”

Association of Multidrug Resistance in Epilepsy with a Polymorphism in the Drug-Transporter GeneABCB1

“…None of the reported associations with clinical drug resistance, such as remote symptomatic causes, early onset, multiple seizure types, and a high frequency of seizures before the initiation of treatment, provide a mechanistic explanation of the phenomenon. [1][2][3] In addition, it is not clear why the same type of epilepsy may be drug-resistant in one person and drugresponsive in another and whether this is a pharmacogenomic phenomenon.…”

Can we predict drug response by volumes of the corpus callosum in newly diagnosed focal epilepsy?

“…more intensive investigations and treatments. Thus, there have been many studies concerning biomarkers for predicting a drug response to AEDs, including disease-, patient-and treatment-related factors (Kim, Park, Kim, Kwon, & No, 2010;Kwan et al, 2008;Liimatainen, Raitanen, Ylinen, Peltola, & Peltola, 2008;MacDonald et al, 2000;Semah et al, 1998;Siddiqui et al, 2003). Of these factors, the single most important factor for the response to AEDs is the etiology of epilepsy.…”