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Early Identification of Refractory Epilepsy
Open accessAbstract
BACKGROUND: More than 30 percent of patients with epilepsy have inadequate control of seizures with drug therapy, but why this happens and whether it can be predicted are unknown. We studied the response to antiepileptic drugs in patients with newly diagnosed epilepsy to identify factors associated with subsequent poor control of seizures. METHODS: We prospectively studied 525 patients (age, 9 to 93 years) who were given a diagnosis, treated, and followed up at a single center between 1984 and 1997. Epilepsy was classified as idiopathic (with a presumed genetic basis), symptomatic (resulting from a structural abnormality), or cryptogenic (resulting from an unknown underlying cause). Patients were considered to be seizure-free if they had not had any seizures for at least one year. RESULTS: Among the 525 patients, 333 (63 percent) remained seizure-free during antiepileptic-drug treatment or after treatment was stopped. The prevalence of persistent seizures was higher in patients with symptomatic or cryptogenic epilepsy than in those with idiopathic epilepsy (40 percent vs. 26 percent, P=0.004) and in patients who had had more than 20 seizures before starting treatment than in those who had had fewer (51 percent vs. 29 percent, P<0.001). The seizure-free rate was similar in patients who were treated with a single established drug (67 percent) and patients who were treated with a single new drug (69 percent). Among 470 previously untreated patients, 222 (47 percent) became seizure-free during treatment with their first antiepileptic drug and 67 (14 percent) became seizure-free during treatment with a second or third drug. In 12 patients (3 percent) epilepsy was controlled by treatment with two drugs. Among patients who had no response to the first drug, the percentage who subsequently became seizure-free was smaller (11 percent) when treatment failure was due to lack of efficacy than when it was due to intolerable side effects (41 percent) or an idiosyncratic reaction (55 percent). CONCLUSIONS: Patients who have many seizures before therapy or who have an inadequate response to initial treatment with antiepileptic drugs are likely to have refractory epilepsy.
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“the remaining 30% have drug-resistant epilepsy requiring consideration of surgical intervention, ketogenic dietary therapy, vagus nerve stimulation, or other neuromodulatory approaches6,7”
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“While approximately 70% of patients can achieve seizure freedom with appropriate antiepileptic drug (AED) therapy”
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Metadata
- Authors
- Kwan, P., & Brodie, M. J.
- Affiliations
- Western Infirmary (GB)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2000-02-03
- Volume
- 342
- Issue
- 5
- Pages
- 314-319
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W1974809694
- Cited by
- 5,204
- References
- 39
- Citations by year
- 2026: 225 · 2025: 241 · 2024: 259 · 2023: 275 · 2022: 269 · 2021: 328 · 2020: 348 · 2019: 253 · 2018: 270 · 2017: 228 · 2016: 249 · 2015: 230 · 2014: 205 · 2013: 233 · 2012: 248
- FWCI
- 55.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- CRC Press eBooks (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Epilepsy research and treatment
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
- Health Sciences › Medicine › Physiology (medical) › Diet and metabolism studies
- Keywords
- drug-resistant epilepsy, antiepileptic drugs, seizure control, newly diagnosed epilepsy, idiopathic epilepsy, symptomatic epilepsy, cryptogenic epilepsy, seizure frequency, predictors of treatment failure, adverse drug reactions, polypharmacy
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Anticonvulsants, Child, Epilepsy, Female, Humans, Male, Middle Aged, Prospective Studies, Remission Induction, Treatment Failure
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