Long‐term applicability of the new <scp>ILAE</scp> definition of epilepsy. Results from the <scp>PRO</scp>‐<scp>LONG</scp> study

Beretta, Simone; Carone, Davide; Zanchi, Clara; Bianchi, Elisa; Pirovano, Marta; Trentini, Claudia; Padovano, Giada; Colombo, Matteo; Cereda, Diletta; Scanziani, Sofia; Giussani, Giorgia; Gasparini, Sara; Bogliun, G.; Ferrarese, Carlo; Beghi, Ettore

doi:10.1111/epi.13854

Cited by 34 publications

(28 citation statements)

References 20 publications

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“…In principle, the diagnosis was made after two or more unprovoked seizures occurring more than a day apart, or a single unprovoked seizure in the presence of risk factors or investigations suggesting a high risk of recurrence including an epileptiform abnormality on electroencephalography (EEG), an epileptogenic lesion on neuroimaging, or remote symptomatic aetiology. This approach is consistent with definitions later published by the International League Against Epilepsy (ILAE) in 2005 and 2014 that have been subsequently validated for patients with a single seizure at diagnosis …”

Section: Methodssupporting

confidence: 82%

“…2014 14 that have been subsequently validated for patients with a single seizure at diagnosis. 15 Patients were classified as untreated if they had not been commenced on ASM therapy, regardless of whether treatment was recommended or declined. The presence or absence of neuroimaging lesions considered to be epileptogenic, 16,17 and epileptiform abnormalities on EEG, 18 were documented.…”

Section: Key Pointmentioning

confidence: 99%

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Treatment initiation decisions in newly diagnosed epilepsy–A longitudinal cohort study

et al. 2020

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Objective To examine the factors and reasons influencing treatment initiation decisions in patients with newly diagnosed epilepsy. Methods We assessed antiseizure medication initiation decisions in adults with newly diagnosed epilepsy seen at first seizure clinics in Western Australia between 1999 and 2016 and followed to 2018. Results Of 610 patients (median age 40 years, 61.0% male), 426 (69.8%) were diagnosed after two or more seizures and 184 (30.2%) after a single seizure with risk factors for recurrence. Treatment was commenced in 427 patients (70.0%) at diagnosis, 112 (18.4%) during follow‐up, mostly after further seizures, whereas 71 (11.6%) remained untreated at last follow‐up. Elders (≥65 years, odds ratio [OR] = 3.06, 95% confidence interval [CI]: 1.62‐5.80), more seizures (OR = 3.48, 95% CI: 2.03‐5.96), and epileptogenic lesions on neuroimaging (OR = 2.15, 95% CI: 1.26‐3.68) had a higher likelihood of treatment at diagnosis. Patients with less than one seizure per year within the preceding year (OR = 0.40, 95% CI: 0.21‐0.73) and of higher socioeconomic status (OR = 0.985, 95% CI: 0.977‐0.994) were less likely to be treated. For 93 patients (15.2%), treatment was not recommended at diagnosis, most commonly because only a single seizure had occurred. Ninety patients (14.8%) declined recommended treatment, mostly because they were unconvinced of the need for treatment or the diagnosis. Significance Thirty percent of adults with newly diagnosed epilepsy were not immediately treated. Treatment initiation in this real‐world cohort was influenced by age, number of seizures prior to diagnosis, imaging findings, patient preferences, and socioeconomic status.

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Section: Methodssupporting

confidence: 82%

Section: Key Pointmentioning

confidence: 99%

Treatment initiation decisions in newly diagnosed epilepsy–A longitudinal cohort study

et al. 2020

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“…The most important strengths are the large sample size, the long follow-up, and the accuracy of the diagnosis and treatment of epilepsy. Moreover, the long-term applicability of the new ILAE definition of epilepsy has been shown using this cohort 23. The main limitations are the retrospective design and the unstructured data collection by the caring physicians.…”

Section: Discussionmentioning

confidence: 96%

Prognostic patterns and predictors in epilepsy: a multicentre study (PRO-LONG)

Beghi

Beretta

Carone

et al. 2019

J Neurol Neurosurg Psychiatry

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ObjectivesTo describe the long-term prognosis of epilepsy and prognostic patterns in a large cohort of newly diagnosed patients and identify prognostic factors.MethodsStudy participants were 13 Italian epilepsy centres with accessible records dating back to 2005 or earlier, complete data on seizure outcome and treatments, precise epilepsy diagnosis, and follow-up of at least 10 years. Records were examined by trained neurology residents for demographics, seizure characteristics, neurological signs, psychiatric comorbidity, first electroencephalogram (EEG) and MRI/CT, epilepsy type and aetiology, antiepileptic drugs (AEDs), and 1-year, 2-year, 5-year and 10-year seizure remissions. Five predefined prognostic patterns were identified: early remission, late remission, relapsing-remitting course, worsening course and no remission. Prognostic factors were assessed using multinomial logistic regression models.Results1006 children and adults were followed for 17 892 person-years (median 16 years; range 10–57). During follow-up, 923 patients (91.7%) experienced 1-year remission. 2-year, 5-year and 10-year remissions were present in 89.5%, 77.1% and 44.4% of cases. 5-year remission was associated with one to two seizures at diagnosis, generalised epilepsy, no psychiatric comorbidity, and treatment with one or two AEDs during follow-up. 10-year remission was associated with one or two AEDs. The most common prognostic pattern was relapsing-remitting (52.2%), followed by early remission (24.5%). 8.3% of cases experienced no remission. Predictors of a relapsing-remitting course were <6 seizures at diagnosis, (presumed) genetic aetiology and no psychiatric comorbidity.ConclusionsFew seizures at diagnosis, generalised epilepsy and no psychiatric comorbidity predict early or late seizure freedom in epilepsy. Achieving remission at any time after the diagnosis does not exclude further relapses.

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“…This study showed a recurrence risk of seizures of 83.6% at 10 years for those diagnosed using the new definition. 14 The recurrence risk using the old definition was 57% at 1 year and 73% at 4 years according to a paper published by Hauser et al 15 Based on the results of the study by Beretta et al, it is clear that not diagnosing individuals with epilepsy after their first seizure who had an abnormal study (e.g., EEG, MRI, computed tomography [CT]) was doing them a disservice. The delay in diagnosis of epilepsy resulted in (1) patient noncompliance with seizure medications due to lack of appreciation for the likelihood of having another seizure and 2clinician's failure to treat.…”

Section: Definitionsmentioning

confidence: 99%

Epilepsy—Definition, Classification, Pathophysiology, and Epidemiology

Falco-Walter

2020

Semin Neurol

163

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Seizures affect the lives of 10% of the global population and result in epilepsy in 1 to 2% of people around the world. Current knowledge about etiology, diagnosis, and treatments for epilepsy is constantly evolving. As more is learned, appropriate and updated definitions and classification systems for seizures and epilepsy are of the utmost importance. Without proper definitions and classification, many individuals will be improperly diagnosed and incorrectly treated. It is also essential for research purposes to have proper definitions, so that appropriate populations can be identified and studied. Imprecise definitions, failure to use accepted terminology, or inappropriate use of terminology hamper our ability to study and advance the field of epilepsy. This article begins by discussing the pathophysiology and epidemiology of epilepsy, and then covers the accepted contemporary definitions and classifications of seizures and epilepsies.

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Long‐term applicability of the new ILAE definition of epilepsy. Results from the PRO‐LONG study

Abstract: Our results support the applicability of the new epilepsy definition in clinical practice. Individual patient characteristics and a personalized diagnostic approach can justify treatment after a single unprovoked seizure.

Cited by 34 publications

References 20 publications

Treatment initiation decisions in newly diagnosed epilepsy–A longitudinal cohort study

Treatment initiation decisions in newly diagnosed epilepsy–A longitudinal cohort study

Prognostic patterns and predictors in epilepsy: a multicentre study (PRO-LONG)

Epilepsy—Definition, Classification, Pathophysiology, and Epidemiology

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