A prospective cohort study of prognosis for newly diagnosed epilepsy in east China

Yanfang Zhang,Lingying Su,Nian Yu,Qing Di

doi:10.1186/1471-2377-13-116

Yanfang Zhang, Lingying Su + Show 2 more

Open Access

https://doi.org/10.1186/1471-2377-13-116

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Abstract

BackgroundLimited data are available on the outcome of antiepileptic drug treatment response in patients of Chinese Han ethnicity with newly diagnosed epilepsy. We sought to explore the prognosis with antiepileptic drug treatment and to identify the predictors of poor drug control of seizures in these patients.MethodsFor at least 2 years, we prospectively followed up a cohort of patients with newly diagnosed epilepsy and analyzed the response to each antiepileptic drug. Cumulative risk for seizure relapse after initial remission achieved was estimated. The patients were divided into two groups (poor and good control) and compared for clinical characteristics.ResultsA total of 180 patients were included. Early remission was reached in 125 (69.44%) patients, 19 (10.56%) patients entered late remission, while 36 (20%) patients failed to achieve remission. The relapse rates were 19.5% at 2 years and 31.9% at 3 years of the follow-up. The response rates of the first throughout the fourth treatment regimens were 60.0%, 16.1%, 2.8%, and 0.6%, respectively. Multiple seizure types and changes in seizure type during treatment were significantly (p = 0.013 and 0.047, respectively) associated with a poor control.ConclusionsThe prognosis of the majority of patients with newly diagnosed epilepsy is good and the clinical pattern of epilepsy during treatment is complex. The chances of seizure control declines with each subsequent treatment regimen. The prognosis for patients with multiple seizure types and seizure type changes during treatment is unfavorable.

Highlights

Limited data are available on the outcome of antiepileptic drug treatment response in patients of Chinese Han ethnicity with newly diagnosed epilepsy
Patient characteristics A total of 212 patients were diagnosed with epilepsy and none had previously received an antiepileptic drug (AED) for any indication
30 out of 72 (42%) children, who failed to respond to the first AED, later achieved remission suggesting that initial drug response cannot reliably predict drug resistance

Summary

Introduction

Limited data are available on the outcome of antiepileptic drug treatment response in patients of Chinese Han ethnicity with newly diagnosed epilepsy. We sought to explore the prognosis with antiepileptic drug treatment and to identify the predictors of poor drug control of seizures in these patients. Seventy million people have epilepsy, with the incidence of 34 – 76 of newly diagnosed cases per 100,000 [1]. While the majority of patients with epilepsy respond well to one antiepileptic drug (AED), nearly up to one third of patients respond poorly to antiepileptic therapy with two or more AEDs, or develop drug-resistant epilepsy (DRE). Early identification of patients who are at high risk of developing DRE is crucial. While the risk factors influencing the prognosis of epilepsy have begun to be appreciated [4,5,6,7], limited data are

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