Cited by 5,204Epilepsy research and treatmentPharmacological Effects and Toxicity StudiesDiet and metabolism studies

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Early Identification of Refractory Epilepsy

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Kwan, Patrick, Brodie, Martin J.·2000·New England Journal of Medicine

DOI 10.1056/nejm200002033420503

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Abstract

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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Authors: Kwan, P., & Brodie, M. J.
Affiliations: Western Infirmary (GB)
ORCID: Kwan, Patrick
Brodie, Martin J.
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
DOI: 10.1056/nejm200002033420503
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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