Is Epilepsy Intractability Predetermined or Acquired?

Abstract

How Long Does it Take for Epilepsy to Become Intractable? A Prospective Investigation Berg AT, Vickrey BG, Testa FM, Levy SR, Shinnar S, DiMario F, Smith S. Ann Neurol 2006;60:73–79. Objective To determine prospectively when in the course of epilepsy intractability becomes apparent. Methods Data are from a prospective cohort of 613 children followed for a median of 9.7 years. Epilepsy syndromes were grouped as focal, idiopathic, catastrophic, and other. Intractability was defined in two ways: (a) two drugs failed, 1 seizure/month, on average, for 18 months (stringent), and (b) failure of two drugs. Delayed intractability was defined as 3 or more years after epilepsy diagnosis. Results Eighty-three children (13.8%) met the stringent and 142 (23.2%) met the two-drug definition. Intractability depended on syndrome ( p < 0.0001): 26 (31.3%) children meeting stringent and 39 (27.5%) meeting the two-drug definition had delayed intractability. Intractability was delayed more often in focal than catastrophic epilepsy (stringent: 46.2 vs 14.3%, p = 0.003; two-drug: 40.3 vs 2.2%, p = 0.0001). Early remission periods preceded delayed intractability in 65.4–74.3% of cases. After becoming intractable, 20.5% subsequently entered remission and 13.3% were seizure free at last contact. Interpretation Intractable epilepsy may be delayed, especially in focal epilepsy. It often is preceded by a quiescent period, followed by further remissions. These findings help explain why surgically treatable epilepsies may take 20 years or longer before referral to surgery.