Vol 54, No 5 (2020)
Research Paper
Published online: 2020-07-27

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Predictors of remission in patients with epilepsy

Kamil Wężyk1, Agnieszka Słowik2, Magdalena Bosak2
Pubmed: 32757204
Neurol Neurochir Pol 2020;54(5):434-439.

Abstract

Aim of study. To evaluate the rate and factors predicting seizure remission in a large cohort of patients with epilepsy.

Materials and methods. Patients with epilepsy treated at a university epilepsy clinic were included in this study. The following information was collected by means of a structured questionnaire: age, sex, age at onset of epilepsy, aetiology of epilepsy, the presence of intellectual disability, duration and type of epilepsy, frequency of seizures, treatment of epilepsy, and mechanism of action of antiepileptic drugs (AEDs).

Results. A total of 530 adult patients participated in this study (mean age ± standard deviation: 36.1 ± 12.6 years). Of these, 327 (61.7%) were female, and 364 (68.7%) patients had focal epilepsy. Twelve-month seizure freedom was achieved in 246 (46.4%) patients. Logistic regression revealed several independent predictors of seizure freedom: younger age (odds ratio (OR) = 0.98; p = 0.037), male sex (OR = 1.54; p = 0.050), generalised epilepsy (OR = 1.61; p = 0.052), lower number of prescribed AEDs (OR = 0.22; p = 0.001), and taking a combination of valproate and lamotrigine (OR = 2.51; p = 0.024).

Conclusions. Most patients with epilepsy enter remission on monotherapy with their first or second AED. However, a substantial proportion of patients may benefit from combination therapy including valproate and lamotrigine polytherapy.

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References

  1. Jette N, Fiest KM, Sauro KM, et al. Prevalence and incidence of epilepsy: A systematic review and meta-analysis of international studies. Neurology. 2017; 88(3): 296–303.
  2. Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000; 342(5): 314–319.
  3. Chen Z, Brodie MJ, Liew D, et al. Treatment Outcomes in Patients With Newly Diagnosed Epilepsy Treated With Established and New Antiepileptic Drugs: A 30-Year Longitudinal Cohort Study. JAMA Neurol. 2018; 75(3): 279–286.
  4. Scheffer IE, Berkovic S, Capovilla G, et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017; 58(4): 522–530.
  5. Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017; 58(4): 522–530.
  6. Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014; 55(4): 475–482.
  7. Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010; 51(6): 1069–1077.
  8. George D, Mallery PS. for Windows Step by Step: A Simple Guide and Reference, 17. 0 Update 2010 Allyn. : Bacon.
  9. Mäkinen J, Rainesalo S, Raitanen J, et al. The effect of newer antiepileptic drugs in combination therapy. Epilepsy Res. 2017; 132: 15–20.
  10. Gesche J, Christensen J, Hjalgrim H, et al. Epidemiology and outcome of idiopathic generalized epilepsy in adults. Eur J Neurol. 2020; 27(4): 676–684.
  11. Beghi E, Beretta S, Carone D, et al. PRO-LONG Study Group. Prognostic patterns and predictors in epilepsy: a multicentre study (PRO-LONG). J Neurol Neurosurg Psychiatry. 2019; 90(11): 1276–1285.
  12. Steinhoff BJ, Maren Staack A, Wisniewski I. Seizure control with antiepileptic drug therapy in 517 consecutive adult outpatients at the Kork Epilepsy Centre. Epileptic Disord. 2012; 14(4): 379–387.
  13. Bauer J, Buchmüller L, Reuber M, et al. Which patients become seizure free with antiepileptic drugs? An observational study in 821 patients with epilepsy. Acta Neurol Scand. 2008; 117(1): 55–59.
  14. Stephen LJ, Forsyth M, Kelly K, et al. Antiepileptic drug combinations--have newer agents altered clinical outcomes? Epilepsy Res. 2012; 98(2-3): 194–198.
  15. Brodie MJ, Sills GJ. Combining antiepileptic drugs--rational polytherapy? Seizure. 2011; 20(5): 369–375.
  16. Brodie MJ, Yuen AW. Lamotrigine substitution study: evidence for synergism with sodium valproate? 105 Study Group. Epilepsy Res. 1997; 26(3): 423–432.
  17. Johannessen SI, Landmark CJ. Antiepileptic drug interactions - principles and clinical implications. Curr Neuropharmacol. 2010; 8(3): 254–267.
  18. Zaccarra G, Perrucca E. Interactions Between Antiepileptic Drugs, and Between Antiepileptic Drugs and Other Drugs. Epileptic Disord. 2014; 16: 409–31.
  19. Brigo F, Ausserer H, Tezzon F, et al. When one plus one makes three: the quest for rational antiepileptic polytherapy with supraadditive anticonvulsant efficacy. Epilepsy Behav. 2013; 27(3): 439–442.
  20. Mohanraj R, Brodie MJ. Pharmacological outcomes in newly diagnosed epilepsy. Epilepsy Behav. 2005; 6(3): 382–387.
  21. Beghi E, Giussani G, Sander JW. The natural history and prognosis of epilepsy. Epileptic Disord. 2015; 17(3): 243–253.
  22. Beghi E, Giussani G, Sander JW. The natural history and prognosis of epilepsy. Epileptic Disord. 2015; 17(3): 243–253.
  23. Abimbola S, Martiniuk ALC, Hackett ML, et al. Early predictors of remission in newly diagnosed epilepsy: a systematic approach to reviewing prognostic factor studies. Neurol Res. 2014; 36(1): 1–12.
  24. Nowak A, Rysz A, Dziedzic T, et al. Predictors of Class I epilepsy surgery outcome in tumour-related chronic temporal lobe epilepsy in adults. Neurol Neurochir Pol. 2019; 53(6): 466–475.
  25. Hamedi-Shahraki S, Eshraghian MR, Yekaninejad MS, et al. Health-related quality of life and medication adherence in elderly patients with epilepsy. Neurol Neurochir Pol. 2019; 53(2): 123–130.
  26. Kuzmanova R, Stefanova I, Stambolieva K. Significance of noncompliance when treating patients with epilepsy. Neurol Neurochir Pol. 2018; 52(2): 215–221.
  27. Jędrzejczak J, Mazurkiewicz-Bełdzińska M, Szmuda M, et al. Convulsive status epilepticus management in adults and children: Report of the Working Group of the Polish Society of Epileptology. Neurol Neurochir Pol. 2018; 52(4): 419–426.



Neurologia i Neurochirurgia Polska