Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-13T01:05:45.334Z Has data issue: false hasContentIssue false
  • English
  • Français

Predictors of Unfavourable Seizure Outcome in Patients with Epilepsy in Nepal

Published online by Cambridge University Press:  02 December 2014

Subash Lohani ,
Upendra P. Devkota  and
Hemav Rajbhandari
Subash Lohani*
Affiliation:
National Institute of Neurological and Allied Sciences
Upendra P. Devkota
Affiliation:
National Institute of Neurological and Allied Sciences
Hemav Rajbhandari
Affiliation:
Nepal Epilepsy Association, Lazimpat, Kathmandu, Nepal
*
National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal.
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Despite optimal medical therapy, a sizeable number of patients continue to have persistent seizures. We evaluated the association of pretreatment and treatment variables with unfavorable seizure outcome.

Methods:

Patients with follow-up over 12 years in the Nepal Epilepsy Association were evaluated. Patients having seizures for at least a year and already on polytherapy after failure of two monotherapy trials were considered having unfavourable outcome. Variables under study were: age, sex, duration and frequency of seizures prior to treatment, type of seizure, neurological status, Computed Tomography (CT) finding, and failure of first anti-epileptic drug (AED). Bivariate analysis was done with Chi-square and Fisher exact tests. Potential interaction between variables was studied with a logistic regression analysis.

Results:

Out of a total 529 consecutive patients, 490 were included in the study. Unfavorable seizure outcome was seen in 26.8% of patients. Among 284 patients who remained viable for analysis, bivariate analysis showed significant association of unfavorable outcome with frequency of seizure (p 0.01), abnormal neurological status (p 0.01) and failure of first AED (p 0.00), while no significant association was seen with age at onset (p 0.45), sex (p 0.47), duration of seizure (p 0.43), type of seizure (p 0.12), and presence of CT abnormality (p 0.46). The fitted regression model portended an unfavorable prognosis with failure of first AED and abnormal neurological status, however, failed to show significant association with frequency of seizure.

Conclusions:

Failure of first AED trial and associated neurological deficits are significant predictors of unfavorable seizure outcome.

Résumé:

RÉSUMÉ: Contexte:

Un nombre appréciable de patients continue à présenter des crises malgré un traitement médical optimal. Nous avons évalué l’association entre certaines variables avant et après traitement chez les patients dont les crises n’étaient pas bien contrôlées.

Méthodes:

Nous avons évalué les patients de la Nepal Epilepsy Association qui étaient suivis depuis plus de 12 ans. Les patients qui avaient des crises depuis au moins un an et qui étaient déjà sous polythérapie suite à un échec d’au moins deux essais de monothérapie ont été considérés comme ayant un mauvais résultat. Nous avons étudié les variables suivantes : l’âge, le sexe, la durée et la fréquence des crises avant traitement, le type de crises, l’état neurologique, les constatations à la tomodensitométrie et l’échec du traitement par le premier médicament antiépileptique (MAE). Une analyse bivariée a été effectuée au moyen du chi–carré et du test de Fisher, et l’interaction entre les variables a été évaluée au moyen de l’analyse de régression logistique.

Résultats:

Quatre cent quatre–vingt–dix des 529 patients consécutifs ont été inclus dans l’étude. Une issue défavorable a été observée chez 26,8% des patients. Parmi les 284 patients analysables, l’analyse bivariée a montré une association significative entre une issue défavorable et la fréquence des crises (p = 0,01), un état neurologique anormal (p = 0,01) et un échec du premier MAE (p = 0,00). Aucune association significative n’a été observée avec l’âge de début ( p = 0,45), le sexe (p = 0,47), la durée des crises (p = 0,43), le type de crises (p = 0,12) et la présence d’anomalies à la tomodensitométrie (p = 0,46). Le modèle de régression ajusté qui prédisait un pronostic défavorable en présence d’un échec du premier MAE et d’un état neurologique anormal ne montrait cependant pas d’association significative avec la fréquence des crises.

Conclusions:

L’échec du traitement par le premier MAE et la présence de déficits neurologiques sont des facteurs qui prédisent une mauvaise réponde au traitement.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 1 , January 2010 , pp. 76 - 80
Copyright
Copyright © The Canadian Journal of Neurological 2010

References

1. Rajbhandari, KC. Epilepsy in Nepal. Can J Neurol Sci. 2004;31(2): 257–60.CrossRefGoogle ScholarPubMed
2. Hauser, WA, Annegers, JF, Kurland, LT. Incidence of epilepsy and unprovoked seizure in Roshester Minnesota 1935-1984. Epilepsia. 1993;34(3):453–68.Google Scholar
3. Placencia, M, Shorvon, SD, Paredes, V, Bimos, C, Sander, JW, Suarez, J, et al. Epileptic seizures in the Andean region of Ecuador. Incidence and prevalence and regional variation. Brain. 1992;115(Pt 3):771–82.Google Scholar
4. Sander, JW. Some aspects of prognosis in the epilepsies: a review. Epilepsia. 1993;34(6):1007–16.Google Scholar
5. Annegers, JF, Hauser, WA, Elveback, LR. Remission of seizures and relapse in patients with epilepsy. Epilepsia. 1979;20(6):729–37.Google Scholar
6. Berg, AT, Shinnar, S, Levy, SR, Testa, FM, Smith-Rapaport, S, Beckerman, B. Early development of intractable epilepsy in children. Neurology. 2001;56(11):1445–52.Google Scholar
7. Camfield, C, Camfield, P, Gordon, K, Dooley, J. Does the number of seizures before treatment influence ease of control or remission of childhood epilepsy? Not if the number is 10 or less. Neurology. 1996;46(1):41–4.Google Scholar
8. Camfield, PR, Camfield, CS, Gordon, K, Dooley, JM. If a first antiepileptic drug fails to control a child’s epilepsy, what are the chances of success with the next drug? J Pediatr. 1997;131 (6):821–4.Google Scholar
9. Collaborative Group for the Study of Epilepsy. Prognosis of epilepsy in newly referred patients: a multicenter prospective study of the effects of monotherapy on the long-term course of epilepsy. Epilepsia. 1992;33(1):45–51.Google Scholar
10. Kwan, P, Brodie, MJ. Early identification of refractory epilepsy. N Engl J Med. 2000;342(5):314–9.CrossRefGoogle ScholarPubMed
11. Mattson, RH, Cramer, JA, Collins, JF. Prognosis for total control of complex partial and secondarily generalized tonic clonic seizures. Department of Veterans Affairs Epilepsy Cooperative Studies No. 118 and No. 264 Group. Neurology. 1996;47(1): 68–76.Google Scholar
12. Schmidt, D. How reliable is early treatment response in predicting long term seizure outcome. Epilepsy Behav. 2007;10(4):588–94.Google Scholar
13. Semah, F, Picot, MC, Adam, C, Broglin, D, Arzimanoglou, A, Bazin, B, et al. Is the underlying cause of epilepsy a major prognostic factor for recurrence? Neurology. 1998;51(5):1256–62.Google Scholar
14. Shinnar, S, Berg, AT. Does antiepileptic drug therapy prevent the development of chronic epilepsy? Epilepsia. 1996;37(8):701–8.Google Scholar
15. Sillanpää, M. Remission of seizures and predictors of intractability in long-term follow-up. Epilepsia. 1993;34(5):930–6.CrossRefGoogle ScholarPubMed
16. Sillanpää, M, Jalava, M, Kaleva, O, Shinnar, S. Long-term prognosis of seizures with onset in childhood. N Engl J Med. 1998;338(24):1715–22.Google Scholar
17. Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia. 1981;22:489–501.Google Scholar
18. Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia. 1989;30(4): 389–99.Google Scholar
19. Rapport, RL 2nd, Ojemann, GA, Wyler, AR, Ward, AA Jr. Surgical management of epilepsy. West J Med. 1977;127(3):185–9.Google ScholarPubMed
20. Langfitt, JT, Wiebe, S. Early surgical treatment for epilepsy. Curr Opin Neurol. 2008;21(2):179–83.Google Scholar
21. Schmidt, D, Richter, K. Alternative single anticonvulsant drug therapy for refractory epilepsy. Ann Neurol. 1986;19(1):85–7.CrossRefGoogle ScholarPubMed
22. Reynolds, EH. Do anticonvulsants alter the natural course of epilepsy? Treatment should be started as early as possible. BMJ. 1995;310(6973):176–7.Google Scholar
23. Girija, AS. Medical management of intractable epilepsy. Calicut Med J. 2004 2(4):e6; doi: Available from: http://www.calicutmedicaljournal.org/2004/2/4/e6. http://www.calicutmedicaljournal.org/2004/2/4/e6 Google Scholar
24. Gupta, M, Agarwal, P, Khwaja, GA, Chowdhury, D, Sharma, B, Bansal, J, et al. Randomized prospective study of outcome of short term antiepileptic treatment in small single enhancing CT lesion in brain. Neurol India. 2002;50(2):145–7.Google Scholar
25. Murthy, JM, Subba Reddy, YV. Prognosis of epilepsy associated with single CT enhancing lesion: a long term follow up study. J Neurol Sci. 1998;159:151–5.CrossRefGoogle ScholarPubMed
26. Garg, RK, Nag, D. Single enhancing CT lesion in Indian patients with seizures: clinical and radiological evaluation and follow up. J Trop Pediatrics. 1999;44:204–10.Google Scholar
27. Berg, AT, Levy, SR, Novotny, EJ, Shinnar, S. Predictors of intractable epilepsy in childhood. A case control study. Epilepsia. 1996;37(1):24–30.CrossRefGoogle ScholarPubMed