Treatment response in newly diagnosed epilepsy: a syndromic approach

To investigate the seizure outcome and factors associated with that in patients with newly diagnosed epilepsy, based on a syndromic approach [i.e. idiopathic generalized epilepsies (IGEs) vs. symptomatic generalized epilepsies (SGEs) vs. focal epilepsies vs. unclassified epilepsy].

This was a retrospective longitudinal study of a prospectively developed database. All newly-diagnoses patients with a diagnosis of IGE, focal epilepsy, SGE, or unclassified epilepsy, who received treatment from 2008 until 2018, were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran. All patients had to be followed at our center for at least 14 months.

Four hundred and ten patients were studied [208 people with focal epilepsy (50.7%), 130 with IGE (31.7%), 49 with SGE (12%), and 23 patients with unclassified epilepsy (5.6%)]. Overall, 216 (52.7%) individuals became seizure-free for at least one year after their first therapeutic plan. The second therapeutic attempt in patients, who did not achieve seizure freedom with the first treatment plan, yielded seizure-free outcome in 52 patients (28.7%). The odds ratio of drug-resistance in patients with focal epilepsy compared with that in those with IGE was 1.816 (95% CI: 1.039-3.171; p = 0.036). The odds ratio of drug-resistance in patients with SGE compared with that in those with IGE was 8.543 (95% CI: 3.993-18.274; p = 0.0001).

Implementation of appropriate personalized treatment plans in PWE is of paramount significance and the primary step towards such a strategy is to making a syndromic diagnosis of the condition.