Long-term prognosis of epilepsy, prognostic patterns and drug resistance: a population-based study

G. Giussani, Valentina Canelli, Elisa Bianchi, Giuseppe Erba, C. Franchi, Alessandro Nobili, J. W. Sander, Ettore Beghi, Elio Agostoni, Larissa Airoldi, Francesco Basso, Marialuisa Carpanelli, Mariolina Di Stefano, Andrea Magnoni, Ottaviano Martinelli, A. Rigamonti, Andrea Salmaggi, Lorenzo Stanzani, Cristina Volpe, Nicoletta ZanottaNicoletta Zanotta, Claudio Zucca, Flavio Arienti, Graziano Rocco Arrigoni, Giancarlo Balestra, Piercarla Ballabio, Stefano Marco Balossi, Maria Rita Baratti, Fabrizia Enrica Barteselli, Fausto Bellani, Mauro Bellani, Gianpiero Bellini, Pier Aldo Beretta, Roberto Beretta, Massimo Bergamini, Annalisa Bertella, Francesco Bertolini, Francesco Bertolini, Marcellino Bianchi, Patrizia Bigiolli, Giuseppe Binda, Gigliola Biondelli, Libero Bodega, Edoardo Giovanni Bolis, Marco Vincenzo Carlo Bolla, Carlo Ambrogio Bonacina, Marco Bonfanti, Fausta Borghetti, Roberto Brambilla, Wilma Brancaleone, Francesco Brusadelli, Sabine Bub, Giovanna Caccia, Myriam Caglio, Carlo Calvi Rossi, Daniela Capra, Davide Carone, Giuseppe Carì, Silvio Carrera, Rosalia Cavenago, Maria Luisa Cecchetti, Bice Antonella Centonze, Fabio Cereghini, Ciro Cerrone, Maria Pia Ciappetta, Bruno Cogliati, Ombretta Colombano, Alberto Colombo, Daniela Colombo, Maria Lia Corti, Nicla Cremonini, Marco Crippa, Rolando Antonio Crippa, Mario Crotta, Salvatore Curto, Patrizia Daielli, Domenico De Gilio, Giuseppe Pasquale De Pascalis, Elena Decet, Luigi Della Morte, Felice Duvia, Antonia Favorito, Roberto Ferrario, Luigi Fezzi, Angela Laura Finzi, Bruno Ugo Fiorentino, Agnese Fornaciari, S. Franceschetti, Silvana Franceschetti, Giovanni Fumagalli, Maurizio Fumagalli, Giuseppe Galbiati, Carlo Andrea Galimberti, Carlo Andrea Galimberti, Barbara Ghiazza, Paolo Ghislanzoni, Laura Gioffredi, Taraneh Hassibi, Simone Julita, Giuseppe Leone, Claudio Levi, Giovanni Locatelli, A. Locati, Enrico Giovanni Longhi, Ingrid Lukacova, Mauro Giovanni Manfroi, Paola Manzoni, Claudio Marcolini, Fabio Minicucci, Mohammed Safwan Martini, Rita Masperi, Sussele Mayan, Valeria Mazzoleni, Antonio Menga, Fiorella Merlini, Enrico Messina, Marta Micheli, Rocco Micò, Andrea Millul, Barbara Montini, Alberto Palazzuolo, Silvano Primo Panzeri, Giovanni Passoni, Laura Pensotti, Maria Marcella Petrone, Roberto Pezzuto, Elisabetta Pigazzini, Nicoletta Pirovano, Margherita Pontiggia, Roberto Pozzi, Carlo Quadrelli, Filomena Rampello, Marco Realini, Giovanni Righetti, Cesare Ripa, Sonia Rivetta, Antonino Romeo, Carlo Rota, Tiziana Rusconi, Andrea Santarpia, Ivana Santi, Luigi Sciani, Gianni Scoccimarro, Eugenio Scopinaro, Angelo Giuseppe Semerano, Daniela Sferco, Anna Ersilia Sirtori, Angela Spandri, Bruno Spinelli, Fausto Stefanoni, Raffaele Taiana, Libero Tamagnini, Laura Tassi, Giorgio Tentori, Augusto Teodoro, Katerina Tinterova, Ampelio Tocchetti, Michela Todeschini, Lorenzo Trezza, Valter Valsecchi, Roberto Vanini, Claudio Felice Vercelloni, Anna Villella, Maria Viola, Pietro Vismara, Daniele Mario Zoboli, Gail Bell, M. Montesano, S. Romi

Research output: Contribution to journalArticlepeer-review

Abstract

Background and purpose: Seizures in most people with epilepsy remit but prognostic markers are poorly understood. There is also little information on the long-term outcome of people who fail to achieve seizure control despite the use of two antiepileptic drugs (drug resistance). Methods: People with a validated diagnosis of epilepsy in whom two antiepileptic drugs had failed were identified from primary care records. All were registered with one of 123 family physicians in an area of northern Italy. Remission (uninterrupted seizure freedom lasting 2 years or longer) and prognostic patterns (early remission, late remission, remission followed by relapse, no remission) were determined. Results: In all, 747 individuals (381 men), aged 11 months to 94 years, were followed for 11 045.5 person-years. 428 (59%) were seizure-free. The probability of achieving 2-year remission was 18% at treatment start, 34% at 2 years, 45% at 5, 52% at 10 and 67% at 20 years (terminal remission, 60%). Epilepsy syndrome and drug resistance were the only independent predictors of 2- and 5-year remission. Early remission was seen in 101 people (19%), late remission in 175 (33%), remission followed by relapse in 85 (16%) and no remission in 166 (32%). Treatment response was the only variable associated with differing prognostic patterns. Conclusion: The long-term prognosis of epilepsy is favourable in most cases. Early seizure remission is not invariably followed by terminal remission and seizure outcome varies according to well-defined patterns. Prolonged seizure remission and prognostic patterns can be predicted by broad syndromic categories and the failure of two antiepileptic drugs.

Original languageEnglish
Pages (from-to)1218-1227
Number of pages10
JournalEuropean Journal of Neurology
Volume23
Issue number7
DOIs
Publication statusPublished - Jul 1 2016

Keywords

  • antiepileptic drug response
  • chronic epilepsy
  • drug resistance
  • prognosis
  • prognostic patterns

ASJC Scopus subject areas

  • Medicine(all)
  • Neurology
  • Clinical Neurology

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