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

Abstract

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.

Treatment response and predictors in patients with newly diagnosed epilepsy in Ethiopia: a retrospective cohort study

“…Similarly, a significant proportion of patients had not experienced remission in earlier studies conducted in China (31%) 9 and Scotland (25%) 13 . We found that remitting-relapsing course was the most common (37.6%) prognostic pattern in line with an Italian study 31 . This indicates that achieving a seizure remission at any time after the start of treatment does not exclude further relapses and adequate follow-up is important for all patients, including patients in remission.…”

Persistent treatment resistance in genetic generalized epilepsy: A long‐term outcome study in a tertiary epilepsy center

“…In our population, 14.6% of the cases showed a persistent treatment resistance, whereas the predominant prognostic pattern was the relapsing-remitting one. The relapsing course has been previously reported as a common pattern in cohorts of patients with both focal and generalized epilepsy, 14,18 and our data further confirm that clinical relapses are frequent among patients with GGE persisting in adult life. Considering the overall prognosis at last medical observation, we found a TR rate substantially similar to other retrospective cohort studies conducted in adult epilepsy centers.…”

“…The following prognostic categories, already illustrated by Beghi et al, 14 were retrospectively identified: early remission (1+ years seizure freedom starting within 2 years after diagnosis and persisting for the entire duration of the follow‐up), late remission (1+ years seizure freedom starting after 2 or more years after diagnosis and persisting for the whole follow‐up), relapsing‐remitting course (2+ periods of seizure freedom lasting 1+ years with intermediate relapses), worsening course (1+ years seizure freedom followed by a relapse without subsequent remission), and no remission (no periods of seizure freedom lasting 1+ years during the entire follow‐up). Persistent treatment resistance was defined as the absence of any period of remission from any seizure type of at least 1 year during the whole duration of the follow‐up, despite the use of two appropriate anti‐epileptic drugs (AEDs) administered at adequate doses (explained in detail in Appendix ).…”

Unanticipated improvement in seizure control in drug-resistant epilepsy- real world observations

“…Prior studies indentified an associated between primary generalized epilepsy and favorable treatment responses in apparently DRE. 11,22] Combined focal and generalized epilepsy was included as a new category in the latest iteration of the ILAE classification of the epilepsies, [17] and as this category includes severe forms of epilepsy, including the epileptic encephalopathies, it unsurprisingly was associated with enduring pharmacoresistance. Numerous studies11-13] identified duration of intractability as a predictor of persistent refractory epilepsy, whereas in our cohort, duration of epilepsy was similar in ASM responders and non-responders.…”

“…In a prospective cohort study, almost 60 % of patients relapsed after becoming seizure free for one year (5.9 years median follow-up). [13] An unpredictable relapsing-remitting pattern of seizure frequency is seen in 16 %-52.2 % of patients with epilepsy [2,22]. In patients with this epilepsy trajectory, periods of seizure freedom may be part of the natural history of the disease and it is debatable whether ASM manipulation prompts remission.…”