Fattori prognostici di farmacoresistenza nell'epilessia dell'infanzia e dell'adolescenza

The International League Against Epilepsy (ILAE) has recently defined drug resistance (DR) as a failure of adequate trials of two tolerated and appropriately chosen and used AED schedules (whether as monotherapies or in combination) to achieve sustained seizure freedom. We studied the prognostic factors of DR in 117 patients affected by epilepsy with onset during childhood or adolescence, with a mean age at the first and the last observation respectively of 3 yrs 3 mths and 9 yrs 10 mths. Patients were divided into two groups: one with DR and the other one without DR. In DR cases some parameters prevailed, in particular presence of symptomatic etiology, lesions on MRI, EEG abnormalities at the onset and positive neurological examination, seizure frequency and seizure clustering, poor or delayed response to first AED. PB, VPA, and CBZ were the most utilized drugs. We reviewed the most relevant 10 variables by multiple logistic regression. The most reliable combinations of DR predictors are: partial or no response to the first AED, the presence of seizure clustering during the course of epilepsy, slightly or very altered neurological examination and long latency between onset of epilepsy and first AED administered at T2; partial or no response to the first AED and positive MRI at T5; positive MRI and absence of generalized seizures at T8; and positive MRI at T10. Our data show that 14.4% of the subjects at T5, 16.6% at T8 and 24.3% at T10 became drug-resistant after discontinuation of an efficacious therapy.