Course of chronic focal epilepsy resistant to anticonvulsant treatment

Sixty-three patients (32 women, 31 men), chronically treated with carbamazepine, phenytoin, valproate and/or phenobarbital, were investigated. Mean age at manifestation of epilepsy was 16.4 years; mean age at onset of documentation of seizure frequency was 33.7 years; mean duration of follow-up was 104.8 months; mean number of documented seizures per patient was 313.2. A statistical analysis of seizure diaries was performed. For each day the entries were the number of seizures per day. Linear trends, the amount of variance of the seizure frequency compared to randomly distributed events, were computed with the resulting coefficients fitting a general linear regression model. Non-random aggregations (clusters) were searched for as well as gaps of seizure manifestation. A similar number of patients exhibited a decrease (30%) or increase (29%) of seizure frequency during the course of epilepsy. The variance of the daily seizure frequency was in most patients (78%) significantly higher or lower (5%) than corresponding random distributions. The coupling coefficient to the day before was significantly larger than zero (indicating seizure clustering) in 57% of patients. Significant rhythmic components in seizure profiles (quasi-weekly or quasi-monthly) were found in 31 patients (both male and female). Periods of increased seizure frequency (clusters) manifested in 62% of patients; seizure gaps of at least 1 year occurred in 29 patients followed by seizure relapses in 20 patients. In conclusion, there is no evidence for a unique type of course in chronic focal epilepsy in patients on antiepileptic drugs.