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The Benefit of Active Drug Trials is Dependent on the Aetiology in Refractory Focal Epilepsy
  1. Suvi P Liimatainen (suvi.liimatainen{at}fimnet.fi)
  1. Neurosciences and Rehabilitation,Tampere University Hospital, Finland
    1. Jani A Raitanen
    1. Tampere School of Public Health, University of Tampere, Finland
      1. Aarne M Ylinen
      1. Neurosciences and Rehabilitation,Tampere University Hospital, Finland
        1. Maria A Peltola
        1. Neurosciences and Rehabilitation,Tampere University Hospital, Finland
          1. Jukka T Peltola
          1. Neurosciences and Rehabilitation,Tampere University Hospital, Finland

            Abstract

            Background:Earlier studies have shown that aetiology makes a difference in the outcome of epilepsy, but there is paucity of follow-up studies to evaluate possibilities on achieving seizure-freedom in the initially refractory epilepsy.

            Methods:We evaluated the cause of epilepsy based on the high resolution brain MRI and patient history in 119 consecutive thoroughly examined adult patients with refractory focal epilepsy followed up in our centre. We also evaluated the influence of the aetiology and duration of epilepsy in this patient cohort on the chances of achieving 12 month remission in a two-year follow-up.

            Results:The major finding was that a substantial group of patients achieved remission; 30 (25%) initially refractory patients achieved at least 12 month remission during follow-up. 40.0% of the patients with cryptogenic aetiology had achieved 12 month remission compared to the 16.2% patients with symptomatic aetiologies (age-adjusted OR 3.74, 95% CI 1.54-9.07, p= 0.004). Aetiologies often considered for surgical treatment (HS, CD, vascular malformation, tumour and dual pathology) carried almost sixfold risk of persistent seizures compared with cryptogenic epilepsy (age-adjusted OR 5.85, 95% CI 2.00-17.11, p=0.001). Patients with vascular malformation and dual pathology as aetiology were most refractory, none being in remission for 12 months. There were also patients achieving 12 month remission after a long period of active epilepsy.

            Conclusions:The high proportion of patients achieving remission encourage physicians to continue with new drug trials especially on patients with no possibilities of epilepsy surgery as well as on those still having seizures after epilepsy surgery.

            • aetiology
            • epilepsy
            • focal
            • refractory
            • seizure freedom

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