Background More than 30 percent of patients with epilepsy haveinadequate control of seizures with drug therapy, but why thishappens and whether it can be predicted are unknown. We studiedthe response to antiepileptic drugs in patients with newly diagnosedepilepsy to identify factors associated with subsequent poorcontrol of seizures.
Methods We prospectively studied 525 patients (age, 9 to 93years) who were given a diagnosis, treated, and followed upat a single center between 1984 and 1997. Epilepsy was classifiedas idiopathic (with a presumed genetic basis), symptomatic (resultingfrom a structural abnormality), or cryptogenic (resulting froman unknown underlying cause). Patients were considered to beseizure-free if they had not had any seizures for at least oneyear.
Results Among the 525 patients, 333 (63 percent) remained seizure-freeduring antiepileptic-drug treatment or after treatment was stopped.The prevalence of persistent seizures was higher in patientswith symptomatic or cryptogenic epilepsy than in those withidiopathic epilepsy (40 percent vs. 26 percent, P=0.004) andin patients who had had more than 20 seizures before startingtreatment than in those who had had fewer (51 percent vs. 29percent, P<0.001). The seizure-free rate was similar in patientswho were treated with a single established drug (67 percent)and patients who were treated with a single new drug (69 percent).Among 470 previously untreated patients, 222 (47 percent) becameseizure-free during treatment with their first antiepilepticdrug and 67 (14 percent) became seizure-free during treatmentwith a second or third drug. In 12 patients (3 percent) epilepsywas controlled by treatment with two drugs. Among patients whohad no response to the first drug, the percentage who subsequentlybecame seizure-free was smaller (11 percent) when treatmentfailure was due to lack of efficacy than when it was due tointolerable side effects (41 percent) or an idiosyncratic reaction(55 percent).
Conclusions Patients who have many seizures before therapy orwho have an inadequate response to initial treatment with antiepilepticdrugs are likely to have refractory epilepsy.
Source Information
From the Epilepsy Unit, University Department of Medicine and Therapeutics, Western Infirmary, Glasgow, Scotland.
Address reprint requests to Dr. Brodie at the Epilepsy Unit, Department of Medicine and Therapeutics, Western Infirmary, Glasgow G11 6NT, Scotland, or at martin.j.brodie{at}clinmed.gla.ac.uk.
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