Abstract
BackgroundTo investigate the prognosis and predictors for seizure control in epileptic patients in China.MethodsEight hundred and twenty patients with epilepsy who visited Xuanwu Hospital from October 2017 to January 2020, were enrolled. The clinical information of the patients was obtained by retrospectively reviewing medical records. Prognostic measures of seizure control included remission, relapse and occurrence of drug resistance. The relationship of prognosis of seizure control with factors such as demographics, clinical characteristics and initial electroencephalography (EEG) features was investigated.ResultsA total of 503 (61.3%) patients experienced a 1-year remission and 330 (49.3% of 669) had a 2-year remission. Idiopathic type of epilepsy (P < 0.001), normal EEG (P < 0.05), number of antiepileptic drugs (P < 0.05) and seizure frequency of < 1 /month (P < 0.001) at the first arrival predicted a remission independently. Of the 503 patients who achieved a 1-year remission, 184 (36.6%) experienced a relapse, due to external reversible causes (58 patients) or with unknown reversible triggers (126 patients). No factors were found to be associated with a relapse (P > 0.05). At the end of the study, 322 patients (39.3%) developed drug resistance. The development of drug resistance was associated with the following factors: symptomatic aetiology of epilepsy, epileptiform abnormality in EEG, number of antiepileptic drugs and seizure frequency of ≥1 /month at first arrival (P < 0.001). For symptomatic epilepsy, patients with meningitis/encephalitis (P = 0.007) were more likely to develop drug-resistant epilepsy than these with other causes.ConclusionsRemission is a common process. The type of epilepsy (idiopathic or symptomatic), EEG features, seizure frequency and treatment history at first arrival are related to both remission and terminal drug resistance. Among various causes of symptomatic epilepsy, meningitis/encephalitis is associated with the worst prognosis of epilepsy.
Highlights
To investigate the prognosis and predictors for seizure control in epileptic patients in China
It has been demonstrated that the idiopathic type of epilepsy [6], the low frequency of initial seizure [7, 8], and a rapid response to therapy [9] are predictors for remission, while the symptomatic aetiology of epilepsy is a negative predictor for its prognosis
In contrast to many studies focusing on remission in a period of time, only a few studies have reported the longterm outcomes after a remission with anti-epilepsy drugs (AEDs) Schiller et al followed a group of patients who entered a 1-year remission, and found that treatment history is the only factor associated with relapse, while the type of epilepsy is not related to the recurrence of seizures after a remission [4]
Summary
To investigate the prognosis and predictors for seizure control in epileptic patients in China. Long-term outcomes of seizure control, such as seizure remission [1,2,3], relapse [4] and drug-resistance [5], can be influenced by many factors, such as the epilepsy type, and causes and frequency of seizure, which are apparent early in the course of diseas e[6]. Choi et al followed intractable epilepsy patients and found that 5 out of 20 them who achieved a remission had an epilepsy relapse They failed to found any clinical factors that could predict subsequent seizure relapse. The extent and related factors for relapse are still waiting to be investigated
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