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[Characteristics of patients with drug-resistant epilepsy in a tertiary hospital]

M Iglesias-Rodríguez¹, V Navarro-Abia², B Barbadillo-Mariscal²

¹Hospital Universitario San Pedro, Logroño, España.

Revista De Neurologia

|November 14, 2024

Insights

Drug-resistant epilepsy (DRE) affects nearly 30% of pediatric epilepsy patients, with structural and genetic causes being most common. Status epilepticus increases DRE risk, often leading to epileptic encephalopathy.

Area of Science:

Pediatric Neurology
Epileptology
Clinical Epidemiology

Context:

Drug-resistant epilepsy (DRE) presents significant challenges in patient management.
DRE is linked to increased comorbidities, healthcare costs, and reduced quality of life.
Understanding DRE incidence and associated factors is crucial for effective treatment strategies.

Purpose:

To determine the cumulative incidence of DRE in a pediatric epilepsy cohort.
To identify etiological factors and clinical characteristics associated with DRE.
To analyze the progression and outcomes of DRE in children.

Summary:

A retrospective study of 325 pediatric epilepsy patients from 2010-2024 revealed a 29% DRE incidence.
Structural (36%) and genetic causes were significantly associated with DRE.
Status epilepticus was a predictor of DRE, with 79% of DRE patients developing epileptic encephalopathy.

Impact:

This study highlights a higher-than-expected incidence of DRE in the pediatric population.
Findings emphasize the importance of early identification and management of risk factors like status epilepticus.
Results inform clinical practice and future research directions for pediatric epilepsy management.

Read full analysis

Abstract

Introduction:

Drug-resistant epilepsy has a cumulative incidence between 14 and 20% of patients with epilepsy. It is associated with more comorbidities and with higher healthcare expenditure and impact on quality of life.

Patients And Methods:

A retrospective longitudinal descriptive study was performed covering the period from 01/01/2010 to 02/28/2024. All patients with epilepsy seen in the Pediatric Neurology unit of our center were collected and a review of medical records was carried out to collect the characteristics and evolution during the study period. The classification and definitions used were those established by the International League Against Epilepsy.

Results:

A total of 325 patients with epilepsy were identified, with a cumulative incidence of DRE of 29%. The most frequent etiology was structural both in all patients with epilepsy (22%), and in drug-resistant epilepsy (36%). A statistically significant association was established between refractoriness and genetic and structural causes, and between having status epilepticus and the development of drug-resistant epilepsy. Seventy-nine percent of patients with drug-resistant epilepsy developed epileptic encephalopathy. The most commonly used antiseizure drug was valproic acid (90%), 19% received a ketogenic diet and 4.2% received epilepsy surgery.

Conclusions:

In our setting the incidence of drug-resistant epilepsy is high, more so than previously described. Genetic and structural etiologies are associated with a higher incidence. Having suffered status epilepticus is associated with refractoriness. A higher incidence was observed in patients with defined electroclinical syndromes, probably influenced by epileptic and developmental encephalopathies.

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