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Epilepsy
Research paper
Prognostic patterns and predictors in epilepsy: a multicentre study (PRO-LONG)
  1. Ettore Beghi1,
  2. Simone Beretta2,
  3. Davide Carone2,
  4. Clara Zanchi2,
  5. Elisa Bianchi1,
  6. Marta Pirovano2,
  7. Claudia Trentini2,
  8. Giada Padovano2,
  9. Matteo Colombo2,
  10. Diletta Cereda2,
  11. Sofia Scanziani2,
  12. Giorgia Giussani1,
  13. Sara Gasparini3,4,
  14. Graziella Bogliun2,
  15. Carlo Ferrarese2
  16. PRO-LONG Study Group
    1. 1 Laboratory of Neurological Disorders, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
    2. 2 Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
    3. 3 Medical and Surgical Sciences Department, School of Medicine, Magna Græcia University of Catanzaro, Viale Europa, Catanzaro, Italy
    4. 4 Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
    1. Correspondence to Dr Ettore Beghi, Neurological Disorders, Istituto Mario Negri, Milano 20156, Italy; ettore.beghi{at}marionegri.it

    Abstract

    Objectives To describe the long-term prognosis of epilepsy and prognostic patterns in a large cohort of newly diagnosed patients and identify prognostic factors.

    Methods Study participants were 13 Italian epilepsy centres with accessible records dating back to 2005 or earlier, complete data on seizure outcome and treatments, precise epilepsy diagnosis, and follow-up of at least 10 years. Records were examined by trained neurology residents for demographics, seizure characteristics, neurological signs, psychiatric comorbidity, first electroencephalogram (EEG) and MRI/CT, epilepsy type and aetiology, antiepileptic drugs (AEDs), and 1-year, 2-year, 5-year and 10-year seizure remissions. Five predefined prognostic patterns were identified: early remission, late remission, relapsing-remitting course, worsening course and no remission. Prognostic factors were assessed using multinomial logistic regression models.

    Results 1006 children and adults were followed for 17 892 person-years (median 16 years; range 10–57). During follow-up, 923 patients (91.7%) experienced 1-year remission. 2-year, 5-year and 10-year remissions were present in 89.5%, 77.1% and 44.4% of cases. 5-year remission was associated with one to two seizures at diagnosis, generalised epilepsy, no psychiatric comorbidity, and treatment with one or two AEDs during follow-up. 10-year remission was associated with one or two AEDs. The most common prognostic pattern was relapsing-remitting (52.2%), followed by early remission (24.5%). 8.3% of cases experienced no remission. Predictors of a relapsing-remitting course were <6 seizures at diagnosis, (presumed) genetic aetiology and no psychiatric comorbidity.

    Conclusions Few seizures at diagnosis, generalised epilepsy and no psychiatric comorbidity predict early or late seizure freedom in epilepsy. Achieving remission at any time after the diagnosis does not exclude further relapses.

    • epilepsy
    • long-term prognosis
    • prognostic patterns
    • prognostic predictors

    https://doi.org/10.1136/jnnp-2019-320883

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      Footnotes

      • Collaborators PRO-LONG Study Group: Romeo A, Lodi M Milano, Viri M Novara, Specchio L, Trivisano M Foggia, Mecarelli O, Zarabla A Roma, Capovilla G, Beccaria F Mantova, Sasanelli F Melegnano, Galimberti CA, Tartara E Pavia, Zamponi N, Cappanera S Ancona, Aguglia U Catanzaro, Ferlazzo E Reggio Calabria, La Neve A, Luisi C, Pontrelli G Bari, Basso P, Pozzi A Gallarate, Cantisani AT, Papetti R Perugia, De Maria G Brescia, Di Francesco J Monza, Albanese J Milano.

      • Contributors Design and conceptualised study, drafted the manuscript for intellectual content: EB. Supervision of data collection, revision of manuscript: SB. Statistical analysis: EB. Data monitoring, literature search, revision of manuscript: GG. Data collection, revision of manuscript: DCa, CZ, MP, CT, GP, MC, DCe, SS, SG, GB, CF.

      • Funding This study was supported by the Italian Ministry of Health (RF-2009-1504361).

      • Competing interests EB reports grants from UCB Pharma and from the Italian Ministry of Health. CF is a consultant of Biogen, Roche and OCM.

      • Patient consent for publication Not required.

      • Ethics approval The study protocol was approved by the Ethics Committee of the San Gerardo Hospital, ASST, Monza, and of all participating centres, with reference number RF-2009-1504361 (Long-term prognosis of epilepsy: a multicentre retrospective survey of prognostic patterns in newly diagnosed patients [PRO-LONG study]).

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data availability statement Data are available upon reasonable request. Anonymised data will be shared on request from any qualified investigator.