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Onset of intractability and its course over time: The Dutch study of epilepsy in childhood
| Content Provider | Scilit |
|---|---|
| Author | Geerts, Ada Brouwer, Oebele Stroink, Hans van Donselaar, Cees Peters, Boudewijn Peeters, Els Arts, Willem F. |
| Copyright Year | 2012 |
| Description | Journal: Epilepsia |
| Abstract | Purpose: Intractability in epilepsy is difficult to define, and little is known about its onset, course, and duration. We investigated these aspects (as well as the occurrence of intractability) during long-term follow-up in patients with epilepsy, focusing on possible explanations for the variation in time of onset and duration of intractability. Methods: After diagnosis, 453 patients with childhood-onset epilepsy had a 5-year follow-up with regular visits and data collection. Ten years later they received a questionnaire with items concerning epilepsy, which was completed by 413 patients resulting in a mean follow-up of 15 years. Intractability during the first 5 years was compared with that in the last year of follow-up. Intractability was defined as having no 3-month remission during a 1-year period despite adequate medical treatment. Key Findings: At least 12.1% of the cohort had a period of intractability during the 15-year follow-up, and 8.5% were intractable in the final year. Of the patients with idiopathic etiology 4.3% had a period of intractability versus 17.0% for those with cryptogenic, and 22.6% for those with remote symptomatic etiology (p < 0.001). Other risk factors at baseline were younger age at first seizure, generalized cryptogenic/symptomatic or localization-related symptomatic epilepsy, mental retardation, and febrile convulsions before enrollment. The cumulative risk of a period of intractability was 6.1% (95% confidence interval [CI] 3.7–8.5) at 2 years follow-up and 8.2% (95% CI 5.4–11.0) at 5 years. The mean time to onset of intractability during the first 5 years of follow-up was 1.6 (95% CI 1.3–2.0; median 1.0) years and the mean duration of intractability during these 5 years was 3.3 (95% CI 2.8–3.8; median 3.6) years. Fifteen patients were intractable only during the first 5 years of follow-up (group A), and 19 subjects were intractable both during the first 5 years and the last year of follow-up (group B). Compared with group A, group B had shorter remission and a longer time to intractability during the first 5 years and more were intractable in the fifth year of follow-up. Sixteen other patients had a late onset of intractability after 5 years of follow-up, sometimes after long periods of remission (group C). No significant differences in baseline characteristics were found among groups A, B, and C, but slightly more children in groups B and C became mentally retarded during the follow-up. In all groups, antiepileptic drugs were of little use in preventing and ending intractability. Significance: There is a large unpredictable variation in time of onset, course, and duration of intractability, with a higher chance of final intractability after a poor course during the first 5 years of follow-up. The natural course of epilepsy probably best explains the variable course of intractability. The effect of medication seems to be minor. |
| Related Links | https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1528-1167.2012.03429.x |
| Ending Page | 751 |
| Page Count | 11 |
| Starting Page | 741 |
| e-ISSN | 15281167 |
| DOI | 10.1111/j.1528-1167.2012.03429.x |
| Journal | Epilepsia |
| Issue Number | 4 |
| Volume Number | 53 |
| Language | English |
| Publisher | Wiley-Blackwell |
| Publisher Date | 2012-03-14 |
| Access Restriction | Open |
| Subject Keyword | Journal: Epilepsia |
| Content Type | Text |
| Resource Type | Article |
