Diagnosing refractory epilepsy: response to sequential treatment schedules

European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies
R Mohanraj, Martin J Brodie

Abstract

Diagnosing refractory epilepsy would facilitate referral for specialist pharmacological review and early consideration of epilepsy surgery. An outcomes study was undertaken in an unselected cohort of newly diagnosed patients to determine the number of antiepileptic drug (AED) regimens needed to be failed before the epilepsy could be designated as pharmacoresistant. Between July 1982 and May 2001, 780 adolescents and adults prescribed their first AED at the Western Infirmary in Glasgow, Scotland provided longitudinal data suitable for analysis. Overall, 504 (64.6%) patients became seizure free for at least 12 months. Of these, 462 (59.2%) remained in remission, while 42 (5.4%) relapsed and subsequently developed refractory epilepsy. The relapse rate peaked at 10.4% after 8 years of follow-up. The other 276 (35.4%) patients were uncontrolled from the outset. Prognosis appeared better in seniors (85% remission, P < 0.001) and adolescents (65% remission, P < 0.01) than in the remainder of the population (55% remission). Overall response rates with the first, second and third treatment schedules were 50.4, 10.7 and 2.7%, respectively, with only 0.8% patients responding optimally to further drug trials. Patients not tolerating at lea...Continue Reading

References

Dec 1, 1979·Epilepsia·J F AnnegersL R Elveback
Jun 12, 1998·The New England Journal of Medicine·M SillanpääS Shinnar
Mar 26, 1999·Seizure : the Journal of the British Epilepsy Association·P Francis, G A Baker
Apr 21, 1999·QJM : Monthly Journal of the Association of Physicians·D SmithD W Chadwick
May 20, 1999·The New England Journal of Medicine·O Devinsky
Feb 5, 2000·The New England Journal of Medicine·P Kwan, M J Brodie
May 3, 2000·Lancet·L J Stephen, M J Brodie
May 29, 2000·Brain : a Journal of Neurology·S M Sisodiya
Jul 6, 2000·Seizure : the Journal of the British Epilepsy Association·S R Benbadis, W Allen Hauser
Nov 9, 2000·Lancet·M J Brodie, J A French
Aug 4, 2001·The New England Journal of Medicine·S WiebeUNKNOWN Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study Group
Apr 12, 2002·Seizure : the Journal of the British Epilepsy Association·Patrick Kwan, Martin J Brodie
Jan 29, 2003·Neurology·A T BergS S Spencer
Aug 27, 2003·Neurology·Edwin Trevathan, Frank Gilliam
Dec 25, 2003·Neurology·Selim R BenbadisMaria Gieron
Jan 30, 2004·Lancet Neurology·William H Theodore, Robert S Fisher
Jun 18, 2004·Brain : a Journal of Neurology·Willem F M ArtsAda T Geerts
Jul 24, 2004·Epilepsia·Daniel F GhougassianTerence J O'Brien

❮ Previous
Next ❯

Citations

May 4, 2010·Current Neurology and Neuroscience Reports·Kanjana UnnwongseNancy Foldvary-Schaefer
Jul 25, 2013·Epilepsy Research·Merel WassenaarSabine G Uijl
Sep 12, 2012·Nature Reviews. Neurology·Samuel Wiebe, Nathalie Jette
Sep 9, 2011·The New England Journal of Medicine·Patrick KwanMartin J Brodie
Feb 27, 2007·Epilepsia·Graeme Sills, Martin Brodie
Feb 22, 2008·Epilepsia·Linda J Stephen, Martin J Brodie
Jun 16, 2011·Epilepsia·Gemma SansaOrrin Devinsky
Aug 16, 2011·Epilepsia·Edward H MaaKevin J Staley
Oct 7, 2011·Epilepsia·Giuseppe ErbaElisabetta Pupillo
Jan 30, 2007·Epilepsy Currents·Jacqueline A French
Oct 15, 2008·Epilepsy Currents·Michael A Rogawski, Michael R Johnson
Dec 3, 2005·BMJ : British Medical Journal·Martin J Brodie, Patrick Kwan
May 11, 2012·Neurology·M J BrodieP Kwan
Jun 27, 2009·Neuropsychiatric Disease and Treatment·Gaetano Zaccara, Luigi M Specchio
May 20, 2009·Pharmacogenomics·Dalia Kasperaviciūte, Sanjay M Sisodiya
Aug 16, 2011·Journal of Neurosurgery·Dario J EnglotKurtis I Auguste
Mar 19, 2014·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Kang Min ParkSung Eun Kim
Sep 8, 2012·Epilepsy Research and Treatment·Katherine C NickelsElaine C Wirrell
Aug 12, 2014·Indian Journal of Pediatrics·Satinder Aneja, Puneet Jain
Oct 14, 2009·Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række·Karl O Nakken, Erik Taubøll
Dec 15, 2012·Expert Review of Neurotherapeutics·Mervyn J Eadie
Jun 16, 2010·Expert Review of Pharmacoeconomics & Outcomes Research·Steven Simoens
Sep 19, 2007·Expert Opinion on Emerging Drugs·Patrick Kwan, Martin J Brodie
Dec 5, 2012·Expert Opinion on Drug Metabolism & Toxicology·Andreas Schulze-Bonhage
Jan 6, 2016·Epilepsy & Behavior : E&B·Giorgia GiussaniUNKNOWN EPIRES Group
Jan 23, 2016·Seizure : the Journal of the British Epilepsy Association·Michal TzadokBruria Ben-Zeev
Jul 21, 2012·Neuroscience·R A B BadawyM J Cook
Jun 5, 2012·Epilepsy & Behavior : E&B·Giuseppe ErbaUNKNOWN OPTEFF Group
Sep 18, 2013·Journal of Neuropathology and Experimental Neurology·Jay R VargasKaren S Wilcox

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.