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Related Experiment Videos

Diagnosing refractory epilepsy: response to sequential treatment schedules.

R Mohanraj1, M J Brodie

  • 1Epilepsy Unit, Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow, Scotland, UK.

European Journal of Neurology
|April 19, 2006
PubMed
Summary

Refractory epilepsy diagnosis can be aided by failing two antiepileptic drug (AED) regimens, suggesting early epilepsy surgery referral. Patients not achieving seizure freedom with three AED schedules likely have refractory epilepsy.

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Area of Science:

  • Neurology
  • Clinical Pharmacology
  • Epileptology

Background:

  • Diagnosing refractory epilepsy is crucial for timely specialist referral and surgical evaluation.
  • Pharmacoresistance in epilepsy impacts treatment strategies and patient outcomes.

Purpose of the Study:

  • To determine the number of antiepileptic drug (AED) regimens failed before designating epilepsy as pharmacoresistant.
  • To identify predictors of long-term seizure freedom and relapse in newly diagnosed epilepsy patients.

Main Methods:

  • Longitudinal outcomes study of 780 newly diagnosed adolescents and adults prescribed their first AED.
  • Data collected between July 1982 and May 2001 at the Western Infirmary, Glasgow.
  • Analysis of seizure freedom, remission, relapse rates, and response to sequential AED regimens.

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Main Results:

  • Overall, 64.6% achieved 12-month seizure freedom; 59.2% remained in remission, while 5.4% relapsed.
  • 35.4% of patients were uncontrolled from the outset.
  • Response rates for first, second, and third AED regimens were 50.4%, 10.7%, and 2.7%, respectively.

Conclusions:

  • Patients failing two AED regimens should be considered for epilepsy surgery referral.
  • Failure to achieve long-term seizure freedom with the first three AED treatment schedules indicates likely refractory epilepsy.
  • Prognosis for seizure freedom was better in seniors and adolescents.