Drug-resistant epilepsy in Saudi Arabia: prevalence, predictive factors, and treatment outcomes

Drug-resistant epilepsy (DRE) is a significant global public health challenge affecting people with epilepsy (PWE). Despite the availability of multiple drug therapies, a significant number of PWE with DRE continue to experience frequent seizures. Current data on the prevalence of DRE and associated risk factors in the Saudi population is limited. This study aimed to estimate and characterize DRE among PWE and identify associated predictive factors.

A cross-sectional study was conducted on PWE who attended Neurology clinics at the National Guard Health Affairs in Riyadh, Saudi Arabia (NGHA-R) between June 2016 and February 2023. Data were collected from patient medical records. Descriptive analyses of continuous and categorical variables were performed. Comparisons between categorical data were conducted using Pearson's chi-squared test. Multivariable logistic regression was used to identify independent factors associated with the development of DRE. A p-value of < 0.05 was considered statistically significant.

A total of 350 patients were analyzed, with a confirmed DRE prevalence of 26.86% (94 out of 350). Age-specific analysis revealed that DRE was most prevalent in the 29-39 age group, accounting for 35.1% (33 out of 94) of cases. The primary predictor for DRE was focal seizure type (AOR = 1.85; 95% CI: 1.05-3.27, p = 0.03). Additionally, DRE patients were more likely to visit the emergency room. Among antiseizure medications, treatment regimens of valproic acid (p = 0.0008), carbamazepine (p = 0.0097), and lamotrigine (p = 0.037) showed significant associations with DRE status.

The prevalence of DRE in Saudi Arabia remains within the previously reported range of global prevalence. Frequent emergency department visits and the use of ASM polytherapy should be followed up closely to ensure early diagnosis of DRE and improve clinical outcomes.