Prevalence of drug resistant epilepsy in adults with epilepsy attending a neurology clinic of a tertiary referral hospital in Singapore

Kong, Sing Teang; Ho, Choon Siang; Ho, Paul C.; Lim, Shih-Hui

doi:10.1016/j.eplepsyres.2014.05.005

Cited by 50 publications

(21 citation statements)

References 35 publications

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“…There was no correlation between the ILAE concordance score and the prevalence estimates. The prevalence estimate in the study with the lowest score of 1 (0.17; 95% CI 0.13‐0.21) was similar to estimates in the study with a score of 7 (0.22; 95% CI 0.18‐0.25) . Likewise, the prevalence estimate in the study with a score of 9 (0.47; 95% CI 0.39‐0.56) was similar to the study with a score of 4 (0.52; 95% CI 0.44‐0.60) .…”

Section: Resultssupporting

confidence: 66%

“…Likewise, the prevalence estimate in the study with a score of 9 (0.47; 95% CI 0.39‐0.56) was similar to the study with a score of 4 (0.52; 95% CI 0.44‐0.60) . Furthermore, the prevalence estimates for studies that had part of the study period after the publication of the ILAE guidelines were not different from studies conducted prior to publishing the ILAE guidelines …”

Section: Resultsmentioning

confidence: 56%

“…The studies were conducted between 1961 and 2012, and most studies (68.5%, n = 24) were published before the ILAE guidelines were available in 2010. There were only 4 studies with part of the study period after 2010 . Most (57.1%, n = 20) were cohort studies, 60.0% (n = 21) only included children (<17 years), and 17.1% (n = 6) and 37.1% (n = 13) were conducted in the United States and Europe, respectively.…”

Section: Resultsmentioning

confidence: 99%

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The epidemiology of drug‐resistant epilepsy: A systematic review and meta‐analysis

et al. 2018

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Objective:The definition of drug-resistant epilepsy (DRE) affects case identification and treatment, and impacts prevalence or incidence estimates and health burden estimation in epidemiology. The objective of this systematic review is to evaluate the consistency between definitions of DRE in the literature and the official definition in the International League Against Epilepsy (ILAE) guidelines, and to estimate the incidence, prevalence, and risk factors for DRE. Methods: MEDLINE and EMBASE were searched for observational studies of DRE published between January 1980 and July 2015. The definitions of DRE in these studies were compared with the definition in the ILAE guidelines. Randomeffect model meta-analyses were used to generate pooled estimates of prevalence or incidence and pooled odds ratios of the association with risk factors. Results: Thirty-five studies met inclusion criteria, including 13 080 epilepsy patients and 3941 patients with DRE. The definition of DRE varied widely across studies, with only 12% meeting the requirements of the ILAE definition. The pooled prevalence proportion of DRE among epilepsy patients was 0.30 (95% confidence interval [CI] 0.19-0.42), and the pooled incidence proportion was 0.15 (95% CI 0.11-0.19). Age at onset, symptomatic epilepsy, abnormal neuroimaging findings, abnormal electroencephalography results, history of mental retardation, neuropsychiatric disorders, febrile seizure, and status epilepticus increased risk for DRE. Significance: There are limited high-quality data available on DRE. Lack of consistency in definitions limits the ability to obtain robust estimates on the burden of DRE. More data based on the ILAE definition from well-designed epidemiologic studies are needed to generate accurate and reliable results. K E Y W O R D Sdrug resistant, epidemiology, epilepsy, frequency, review, risk

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Section: Resultssupporting

confidence: 66%

Section: Resultsmentioning

confidence: 56%

Section: Resultsmentioning

confidence: 99%

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The epidemiology of drug‐resistant epilepsy: A systematic review and meta‐analysis

et al. 2018

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“…18,19 The prevalence of drug-resistant epilepsy ranges from 15.6% to 37%. [20][21][22][23] Drug-resistant epilepsy can lead to increased morbidity and mortality, as well as social disability. [24][25][26] Sudden unexpected death in epilepsy (SUDEP) is the most frequent epilepsy-related cause of death, 18 accounting for approximately 17% of epilepsy-related mortality.…”

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confidence: 99%

Perampanel: Does it have broad‐spectrum potential?

Potschka

Trinka

2018

Epilepsia

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This article reviews the profile of perampanel, a novel noncompetitive α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate (AMPA) receptor antagonist, and its role as a potential broad-spectrum antiepileptic drug in the treatment of epilepsy. For this narrative review, data were collected using specified search criteria. Articles reporting the evidence for perampanel's efficacy from preclinical models, phase 3 clinical studies, observational studies, and descriptive evidence were included. AMPA receptors play a key role in mediating the action of glutamate at the excitatory synapse. Preclinical research showed the AMPA receptor blockade to constitute a promising target for antiepileptic drug therapy. In animal models, perampanel proved to be protective against seizures and reduce seizure severity and duration. Four phase-3 randomized controlled trials (3 in patients with focal seizures and one in primary generalized tonic-clonic seizures in idiopathic generalized epilepsy) have been completed. In focal (partial) onset seizures, perampanel (4, 8, and 12 mg) significantly reduced seizure frequency per 28 days (23.3%-28.8% vs 12.8%; P < .01) and responder rates (≥50% reduction in seizures) (28.5%-35.3% vs 19.3%; P < .05) compared with placebo. In primary generalized tonic-clonic seizures, perampanel 8 mg resulted in greater reduction in seizure frequency per 28 days (-76.5% vs -38.4%; P < .0001) and responder rate (64.2% vs 39.5%; P = .0019) than placebo. The efficacy, safety, and tolerability of perampanel have been reproduced in real-world clinical practice, and the agent has been shown to be effective in other epilepsy syndromes. Perampanel is a potentially broad-spectrum antiepileptic drug with a novel mechanism of action that may be a useful addition for patients with epilepsy with various seizure types. The availability of novel antiepileptic drugs for epilepsy treatment enables more individualized treatment for these patients.

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“…To promote the use of common concepts and a common language, in 2009 the International League Against Epilepsy (ILAE) Task Force proposed to define drug resistance as “failure of adequate trials of two tolerated and appropriately chosen and used antiepileptic drug (AED) schedules (whether as monotherapies or in combination) to achieve sustained seizure freedom.” The assessment of the possible outcomes of an intervention (seizure‐free, treatment failure, and undetermined) by ILAE criteria is largely conceptual and the categorization process needs to be operationalized to determine when a therapeutic trial is “appropriate” (selection of AED based on seizure and patient characteristics) and “adequate” (including good tolerance, optimal dosing schedules, drug adherence and duration of exposure). In situations where appropriateness and adequacy cannot be assessed or satisfied, the outcome is deemed as “undetermined.” The ILAE categorization scheme is increasingly being applied worldwide in studies on drug‐resistant epilepsy …”

Section: Introductionmentioning

confidence: 99%

Do neurologists agree in diagnosing drug resistance in adults with focal epilepsy?

Zaccara

Mula

Ferro³

et al. 2018

Epilepsia

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Objective: To evaluate interrater agreement in categorizing treatment outcomes and drug responsiveness status according to the International League Against Epilepsy (ILAE) definition of drug-resistant epilepsy. Methods: A total of 1053 adults with focal epilepsy considered by the investigators to meet ILAE criteria for drug resistance were enrolled consecutively at 43 centers and followed up prospectively for 18-34 months. Treatment outcomes for all antiepileptic drugs (AEDs) used up to enrollment (retrospective assessment), and on an AED newly introduced at enrollment, were categorized by individual investigators and by 2 rotating members of a 16-member expert panel (EP) that reviewed the patient records independently. Interrater agreement was tested by Cohen's kappa (k) statistics and rated according to Landis and Koch's criteria. Results: Agreement between EP members in categorizing outcomes on the newly introduced AED was almost perfect (90.1%, k = 0.84, 95% confidence interval [CI] 0.80-0.87), whereas agreement between the EP and individual investigators was moderate (70.4%, k = 0.57, 95% CI 0.53-0.61). Similarly, categorization of outcomes on previously used AEDs was almost perfect between EP members (91.7%, k = 0.83, 95% CI 0.81-0.84) and moderate between the EP and investigators (68.2%, k = 0.50, 95% CI 0.48-0.52). Disagreement was related predominantly to outcomes considered to be treatment failures by the investigators but categorized as undetermined by the EP. Overall, 19% of patients classified as having drug-resistant epilepsy by the investigators were considered by the EP to have "undefined responsiveness."Significance: Interrater agreement in categorizing treatment outcomes according to ILAE criteria ranges from moderate to almost perfect. Nearly 1 in 5 patients considered by enrolling neurologists to be "drug-resistant" were classified by the EP as having "undefined responsiveness."

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Prevalence of drug resistant epilepsy in adults with epilepsy attending a neurology clinic of a tertiary referral hospital in Singapore

Cited by 50 publications

References 35 publications

The epidemiology of drug‐resistant epilepsy: A systematic review and meta‐analysis

The epidemiology of drug‐resistant epilepsy: A systematic review and meta‐analysis

Perampanel: Does it have broad‐spectrum potential?

Do neurologists agree in diagnosing drug resistance in adults with focal epilepsy?

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