Long-term prognosis of epilepsy, prognostic patterns and drug resistance: a population-based study

G. Giussani; Valentina Canelli; Elisa Bianchi; Giuseppe Erba; C. Franchi; Alessandro Nobili; J. W. Sander; Ettore Beghi; Elio Agostoni; Larissa Airoldi; Francesco Basso; Marialuisa Carpanelli; Mariolina Di Stefano; Andrea Magnoni; Ottaviano Martinelli; A. Rigamonti; Andrea Salmaggi; Lorenzo Stanzani; Cristina Volpe; Nicoletta Zanotta; Nicoletta Zanotta; Claudio Zucca; Flavio Arienti; Graziano Rocco Arrigoni; Giancarlo Balestra; Piercarla Ballabio; Stefano Marco Balossi; Maria Rita Baratti; Fabrizia Enrica Barteselli; Fausto Bellani; Mauro Bellani; Gianpiero Bellini; Pier Aldo Beretta; Roberto Beretta; Massimo Bergamini; Annalisa Bertella; Francesco Bertolini; Francesco Bertolini; Marcellino Bianchi; Patrizia Bigiolli; Giuseppe Binda; Gigliola Biondelli; Libero Bodega; Edoardo Giovanni Bolis; Marco Vincenzo Carlo Bolla; Carlo Ambrogio Bonacina; Marco Bonfanti; Fausta Borghetti; Roberto Brambilla; Wilma Brancaleone; Francesco Brusadelli; Sabine Bub; Giovanna Caccia; Myriam Caglio; Carlo Calvi Rossi; Daniela Capra; Davide Carone; Giuseppe Carì; Silvio Carrera; Rosalia Cavenago; Maria Luisa Cecchetti; Bice Antonella Centonze; Fabio Cereghini; Ciro Cerrone; Maria Pia Ciappetta; Bruno Cogliati; Ombretta Colombano; Alberto Colombo; Daniela Colombo; Maria Lia Corti; Nicla Cremonini; Marco Crippa; Rolando Antonio Crippa; Mario Crotta; Salvatore Curto; Patrizia Daielli; Domenico De Gilio; Giuseppe Pasquale De Pascalis; Elena Decet; Luigi Della Morte; Felice Duvia; Antonia Favorito; Roberto Ferrario; Luigi Fezzi; Angela Laura Finzi; Bruno Ugo Fiorentino; Agnese Fornaciari; S. Franceschetti; Silvana Franceschetti; Giovanni Fumagalli; Maurizio Fumagalli; Giuseppe Galbiati; Carlo Andrea Galimberti; Barbara Ghiazza; Paolo Ghislanzoni; Laura Gioffredi; Taraneh Hassibi; Simone Julita; Giuseppe Leone; Claudio Levi; Giovanni Locatelli; A. Locati; Enrico Giovanni Longhi; Ingrid Lukacova; Mauro Giovanni Manfroi; Paola Manzoni; Claudio Marcolini; Fabio Minicucci; Mohammed Safwan Martini; Rita Masperi; Sussele Mayan; Valeria Mazzoleni; Antonio Menga; Fiorella Merlini; Enrico Messina; Marta Micheli; Rocco Micò; Andrea Millul; Barbara Montini; Alberto Palazzuolo; Silvano Primo Panzeri; Giovanni Passoni; Laura Pensotti; Maria Marcella Petrone; Roberto Pezzuto; Elisabetta Pigazzini; Nicoletta Pirovano; Margherita Pontiggia; Roberto Pozzi; Carlo Quadrelli; Filomena Rampello; Marco Realini; Giovanni Righetti; Cesare Ripa; Sonia Rivetta; Antonino Romeo; Carlo Rota; Tiziana Rusconi; Andrea Santarpia; Ivana Santi; Luigi Sciani; Gianni Scoccimarro; Eugenio Scopinaro; Angelo Giuseppe Semerano; Daniela Sferco; Anna Ersilia Sirtori; Angela Spandri; Bruno Spinelli; Fausto Stefanoni; Raffaele Taiana; Libero Tamagnini; Laura Tassi; Giorgio Tentori; Augusto Teodoro; Katerina Tinterova; Ampelio Tocchetti; Michela Todeschini; Lorenzo Trezza; Valter Valsecchi; Roberto Vanini; Claudio Felice Vercelloni; Anna Villella; Maria Viola; Pietro Vismara; Daniele Mario Zoboli; Gail Bell; M. Montesano; S. Romi

doi:10.1111/ene.13005

Long-term prognosis of epilepsy, prognostic patterns and drug resistance: a population-based study

G. Giussani, Valentina Canelli, Elisa Bianchi, Giuseppe Erba, C. Franchi, Alessandro Nobili, J. W. Sander, Ettore Beghi, Elio Agostoni, Larissa Airoldi, Francesco Basso, Marialuisa Carpanelli, Mariolina Di Stefano, Andrea Magnoni, Ottaviano Martinelli, A. Rigamonti, Andrea Salmaggi, Lorenzo Stanzani, Cristina Volpe, Nicoletta ZanottaNicoletta Zanotta, Claudio Zucca, Flavio Arienti, Graziano Rocco Arrigoni, Giancarlo Balestra, Piercarla Ballabio, Stefano Marco Balossi, Maria Rita Baratti, Fabrizia Enrica Barteselli, Fausto Bellani, Mauro Bellani, Gianpiero Bellini, Pier Aldo Beretta, Roberto Beretta, Massimo Bergamini, Annalisa Bertella, Francesco Bertolini, Francesco Bertolini, Marcellino Bianchi, Patrizia Bigiolli, Giuseppe Binda, Gigliola Biondelli, Libero Bodega, Edoardo Giovanni Bolis, Marco Vincenzo Carlo Bolla, Carlo Ambrogio Bonacina, Marco Bonfanti, Fausta Borghetti, Roberto Brambilla, Wilma Brancaleone, Francesco Brusadelli, Sabine Bub, Giovanna Caccia, Myriam Caglio, Carlo Calvi Rossi, Daniela Capra, Davide Carone, Giuseppe Carì, Silvio Carrera, Rosalia Cavenago, Maria Luisa Cecchetti, Bice Antonella Centonze, Fabio Cereghini, Ciro Cerrone, Maria Pia Ciappetta, Bruno Cogliati, Ombretta Colombano, Alberto Colombo, Daniela Colombo, Maria Lia Corti, Nicla Cremonini, Marco Crippa, Rolando Antonio Crippa, Mario Crotta, Salvatore Curto, Patrizia Daielli, Domenico De Gilio, Giuseppe Pasquale De Pascalis, Elena Decet, Luigi Della Morte, Felice Duvia, Antonia Favorito, Roberto Ferrario, Luigi Fezzi, Angela Laura Finzi, Bruno Ugo Fiorentino, Agnese Fornaciari, S. Franceschetti, Silvana Franceschetti, Giovanni Fumagalli, Maurizio Fumagalli, Giuseppe Galbiati, Carlo Andrea Galimberti, Barbara Ghiazza, Paolo Ghislanzoni, Laura Gioffredi, Taraneh Hassibi, Simone Julita, Giuseppe Leone, Claudio Levi, Giovanni Locatelli, A. Locati, Enrico Giovanni Longhi, Ingrid Lukacova, Mauro Giovanni Manfroi, Paola Manzoni, Claudio Marcolini, Fabio Minicucci, Mohammed Safwan Martini, Rita Masperi, Sussele Mayan, Valeria Mazzoleni, Antonio Menga, Fiorella Merlini, Enrico Messina, Marta Micheli, Rocco Micò, Andrea Millul, Barbara Montini, Alberto Palazzuolo, Silvano Primo Panzeri, Giovanni Passoni, Laura Pensotti, Maria Marcella Petrone, Roberto Pezzuto, Elisabetta Pigazzini, Nicoletta Pirovano, Margherita Pontiggia, Roberto Pozzi, Carlo Quadrelli, Filomena Rampello, Marco Realini, Giovanni Righetti, Cesare Ripa, Sonia Rivetta, Antonino Romeo, Carlo Rota, Tiziana Rusconi, Andrea Santarpia, Ivana Santi, Luigi Sciani, Gianni Scoccimarro, Eugenio Scopinaro, Angelo Giuseppe Semerano, Daniela Sferco, Anna Ersilia Sirtori, Angela Spandri, Bruno Spinelli, Fausto Stefanoni, Raffaele Taiana, Libero Tamagnini, Laura Tassi, Giorgio Tentori, Augusto Teodoro, Katerina Tinterova, Ampelio Tocchetti, Michela Todeschini, Lorenzo Trezza, Valter Valsecchi, Roberto Vanini, Claudio Felice Vercelloni, Anna Villella, Maria Viola, Pietro Vismara, Daniele Mario Zoboli, Gail Bell, M. Montesano, S. Romi

Research output: Contribution to journal › Article › peer-review

Abstract

Background and purpose: Seizures in most people with epilepsy remit but prognostic markers are poorly understood. There is also little information on the long-term outcome of people who fail to achieve seizure control despite the use of two antiepileptic drugs (drug resistance). Methods: People with a validated diagnosis of epilepsy in whom two antiepileptic drugs had failed were identified from primary care records. All were registered with one of 123 family physicians in an area of northern Italy. Remission (uninterrupted seizure freedom lasting 2 years or longer) and prognostic patterns (early remission, late remission, remission followed by relapse, no remission) were determined. Results: In all, 747 individuals (381 men), aged 11 months to 94 years, were followed for 11 045.5 person-years. 428 (59%) were seizure-free. The probability of achieving 2-year remission was 18% at treatment start, 34% at 2 years, 45% at 5, 52% at 10 and 67% at 20 years (terminal remission, 60%). Epilepsy syndrome and drug resistance were the only independent predictors of 2- and 5-year remission. Early remission was seen in 101 people (19%), late remission in 175 (33%), remission followed by relapse in 85 (16%) and no remission in 166 (32%). Treatment response was the only variable associated with differing prognostic patterns. Conclusion: The long-term prognosis of epilepsy is favourable in most cases. Early seizure remission is not invariably followed by terminal remission and seizure outcome varies according to well-defined patterns. Prolonged seizure remission and prognostic patterns can be predicted by broad syndromic categories and the failure of two antiepileptic drugs.

Original language	English
Pages (from-to)	1218-1227
Number of pages	10
Journal	European Journal of Neurology
Volume	23
Issue number	7
DOIs	https://doi.org/10.1111/ene.13005
Publication status	Published - Jul 1 2016

Keywords

antiepileptic drug response
chronic epilepsy
drug resistance
prognosis
prognostic patterns

ASJC Scopus subject areas

Medicine(all)
Neurology
Clinical Neurology

Access to Document

10.1111/ene.13005

Cite this

Giussani, G., Canelli, V., Bianchi, E., Erba, G., Franchi, C., Nobili, A., Sander, J. W., Beghi, E., Agostoni, E., Airoldi, L., Basso, F., Carpanelli, M., Stefano, M. D., Magnoni, A., Martinelli, O., Rigamonti, A., Salmaggi, A., Stanzani, L., Volpe, C., ... Romi, S. (2016). Long-term prognosis of epilepsy, prognostic patterns and drug resistance: a population-based study. European Journal of Neurology, 23(7), 1218-1227. https://doi.org/10.1111/ene.13005

Giussani, G, Canelli, V, Bianchi, E, Erba, G, Franchi, C, Nobili, A, Sander, JW, Beghi, E, Agostoni, E, Airoldi, L, Basso, F, Carpanelli, M, Stefano, MD, Magnoni, A, Martinelli, O, Rigamonti, A, Salmaggi, A, Stanzani, L, Volpe, C, Zanotta, N, Zanotta, N, Zucca, C, Arienti, F, Arrigoni, GR, Balestra, G, Ballabio, P, Balossi, SM, Baratti, MR, Barteselli, FE, Bellani, F, Bellani, M, Bellini, G, Beretta, PA, Beretta, R, Bergamini, M, Bertella, A, Bertolini, F, Bertolini, F, Bianchi, M, Bigiolli, P, Binda, G, Biondelli, G, Bodega, L, Bolis, EG, Bolla, MVC, Bonacina, CA, Bonfanti, M, Borghetti, F, Brambilla, R, Brancaleone, W, Brusadelli, F, Bub, S, Caccia, G, Caglio, M, Rossi, CC, Capra, D, Carone, D, Carì, G, Carrera, S, Cavenago, R, Cecchetti, ML, Centonze, BA, Cereghini, F, Cerrone, C, Ciappetta, MP, Cogliati, B, Colombano, O, Colombo, A, Colombo, D, Corti, ML, Cremonini, N, Crippa, M, Crippa, RA, Crotta, M, Curto, S, Daielli, P, De Gilio, D, De Pascalis, GP, Decet, E, Morte, LD, Duvia, F, Favorito, A, Ferrario, R, Fezzi, L, Finzi, AL, Fiorentino, BU, Fornaciari, A, Franceschetti, S, Franceschetti, S, Fumagalli, G, Fumagalli, M, Galbiati, G, Galimberti, CA, Ghiazza, B, Ghislanzoni, P, Gioffredi, L, Hassibi, T, Julita, S, Leone, G, Levi, C, Locatelli, G, Locati, A, Longhi, EG, Lukacova, I, Manfroi, MG, Manzoni, P, Marcolini, C, Minicucci, F, Martini, MS, Masperi, R, Mayan, S, Mazzoleni, V, Menga, A, Merlini, F, Messina, E, Micheli, M, Micò, R, Millul, A, Montini, B, Palazzuolo, A, Panzeri, SP, Passoni, G, Pensotti, L, Petrone, MM, Pezzuto, R, Pigazzini, E, Pirovano, N, Pontiggia, M, Pozzi, R, Quadrelli, C, Rampello, F, Realini, M, Righetti, G, Ripa, C, Rivetta, S, Romeo, A, Rota, C, Rusconi, T, Santarpia, A, Santi, I, Sciani, L, Scoccimarro, G, Scopinaro, E, Semerano, AG, Sferco, D, Sirtori, AE, Spandri, A, Spinelli, B, Stefanoni, F, Taiana, R, Tamagnini, L, Tassi, L, Tentori, G, Teodoro, A, Tinterova, K, Tocchetti, A, Todeschini, M, Trezza, L, Valsecchi, V, Vanini, R, Vercelloni, CF, Villella, A, Viola, M, Vismara, P, Zoboli, DM, Bell, G, Montesano, M & Romi, S 2016, 'Long-term prognosis of epilepsy, prognostic patterns and drug resistance: a population-based study', European Journal of Neurology, vol. 23, no. 7, pp. 1218-1227. https://doi.org/10.1111/ene.13005

@article{39d92208dc26448d88c4f63e204a95d2,

title = "Long-term prognosis of epilepsy, prognostic patterns and drug resistance: a population-based study",

abstract = "Background and purpose: Seizures in most people with epilepsy remit but prognostic markers are poorly understood. There is also little information on the long-term outcome of people who fail to achieve seizure control despite the use of two antiepileptic drugs (drug resistance). Methods: People with a validated diagnosis of epilepsy in whom two antiepileptic drugs had failed were identified from primary care records. All were registered with one of 123 family physicians in an area of northern Italy. Remission (uninterrupted seizure freedom lasting 2 years or longer) and prognostic patterns (early remission, late remission, remission followed by relapse, no remission) were determined. Results: In all, 747 individuals (381 men), aged 11 months to 94 years, were followed for 11 045.5 person-years. 428 (59%) were seizure-free. The probability of achieving 2-year remission was 18% at treatment start, 34% at 2 years, 45% at 5, 52% at 10 and 67% at 20 years (terminal remission, 60%). Epilepsy syndrome and drug resistance were the only independent predictors of 2- and 5-year remission. Early remission was seen in 101 people (19%), late remission in 175 (33%), remission followed by relapse in 85 (16%) and no remission in 166 (32%). Treatment response was the only variable associated with differing prognostic patterns. Conclusion: The long-term prognosis of epilepsy is favourable in most cases. Early seizure remission is not invariably followed by terminal remission and seizure outcome varies according to well-defined patterns. Prolonged seizure remission and prognostic patterns can be predicted by broad syndromic categories and the failure of two antiepileptic drugs.",

keywords = "antiepileptic drug response, chronic epilepsy, drug resistance, prognosis, prognostic patterns",

author = "G. Giussani and Valentina Canelli and Elisa Bianchi and Giuseppe Erba and C. Franchi and Alessandro Nobili and Sander, {J. W.} and Ettore Beghi and Elio Agostoni and Larissa Airoldi and Francesco Basso and Marialuisa Carpanelli and Stefano, {Mariolina Di} and Andrea Magnoni and Ottaviano Martinelli and A. Rigamonti and Andrea Salmaggi and Lorenzo Stanzani and Cristina Volpe and Nicoletta Zanotta and Nicoletta Zanotta and Claudio Zucca and Flavio Arienti and Arrigoni, {Graziano Rocco} and Giancarlo Balestra and Piercarla Ballabio and Balossi, {Stefano Marco} and Baratti, {Maria Rita} and Barteselli, {Fabrizia Enrica} and Fausto Bellani and Mauro Bellani and Gianpiero Bellini and Beretta, {Pier Aldo} and Roberto Beretta and Massimo Bergamini and Annalisa Bertella and Francesco Bertolini and Francesco Bertolini and Marcellino Bianchi and Patrizia Bigiolli and Giuseppe Binda and Gigliola Biondelli and Libero Bodega and Bolis, {Edoardo Giovanni} and Bolla, {Marco Vincenzo Carlo} and Bonacina, {Carlo Ambrogio} and Marco Bonfanti and Fausta Borghetti and Roberto Brambilla and Wilma Brancaleone and Francesco Brusadelli and Sabine Bub and Giovanna Caccia and Myriam Caglio and Rossi, {Carlo Calvi} and Daniela Capra and Davide Carone and Giuseppe Car{\`i} and Silvio Carrera and Rosalia Cavenago and Cecchetti, {Maria Luisa} and Centonze, {Bice Antonella} and Fabio Cereghini and Ciro Cerrone and Ciappetta, {Maria Pia} and Bruno Cogliati and Ombretta Colombano and Alberto Colombo and Daniela Colombo and Corti, {Maria Lia} and Nicla Cremonini and Marco Crippa and Crippa, {Rolando Antonio} and Mario Crotta and Salvatore Curto and Patrizia Daielli and {De Gilio}, Domenico and {De Pascalis}, {Giuseppe Pasquale} and Elena Decet and Morte, {Luigi Della} and Felice Duvia and Antonia Favorito and Roberto Ferrario and Luigi Fezzi and Finzi, {Angela Laura} and Fiorentino, {Bruno Ugo} and Agnese Fornaciari and S. Franceschetti and Silvana Franceschetti and Giovanni Fumagalli and Maurizio Fumagalli and Giuseppe Galbiati and Galimberti, {Carlo Andrea} and Barbara Ghiazza and Paolo Ghislanzoni and Laura Gioffredi and Taraneh Hassibi and Simone Julita and Giuseppe Leone and Claudio Levi and Giovanni Locatelli and A. Locati and Longhi, {Enrico Giovanni} and Ingrid Lukacova and Manfroi, {Mauro Giovanni} and Paola Manzoni and Claudio Marcolini and Fabio Minicucci and Martini, {Mohammed Safwan} and Rita Masperi and Sussele Mayan and Valeria Mazzoleni and Antonio Menga and Fiorella Merlini and Enrico Messina and Marta Micheli and Rocco Mic{\`o} and Andrea Millul and Barbara Montini and Alberto Palazzuolo and Panzeri, {Silvano Primo} and Giovanni Passoni and Laura Pensotti and Petrone, {Maria Marcella} and Roberto Pezzuto and Elisabetta Pigazzini and Nicoletta Pirovano and Margherita Pontiggia and Roberto Pozzi and Carlo Quadrelli and Filomena Rampello and Marco Realini and Giovanni Righetti and Cesare Ripa and Sonia Rivetta and Antonino Romeo and Carlo Rota and Tiziana Rusconi and Andrea Santarpia and Ivana Santi and Luigi Sciani and Gianni Scoccimarro and Eugenio Scopinaro and Semerano, {Angelo Giuseppe} and Daniela Sferco and Sirtori, {Anna Ersilia} and Angela Spandri and Bruno Spinelli and Fausto Stefanoni and Raffaele Taiana and Libero Tamagnini and Laura Tassi and Giorgio Tentori and Augusto Teodoro and Katerina Tinterova and Ampelio Tocchetti and Michela Todeschini and Lorenzo Trezza and Valter Valsecchi and Roberto Vanini and Vercelloni, {Claudio Felice} and Anna Villella and Maria Viola and Pietro Vismara and Zoboli, {Daniele Mario} and Gail Bell and M. Montesano and S. Romi",

year = "2016",

month = jul,

day = "1",

doi = "10.1111/ene.13005",

language = "English",

volume = "23",

pages = "1218--1227",

journal = "European Journal of Neurology",

issn = "1351-5101",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "7",

}

TY - JOUR

T1 - Long-term prognosis of epilepsy, prognostic patterns and drug resistance

T2 - a population-based study

AU - Giussani, G.

AU - Canelli, Valentina

AU - Bianchi, Elisa

AU - Erba, Giuseppe

AU - Franchi, C.

AU - Nobili, Alessandro

AU - Sander, J. W.

AU - Beghi, Ettore

AU - Agostoni, Elio

AU - Airoldi, Larissa

AU - Basso, Francesco

AU - Carpanelli, Marialuisa

AU - Stefano, Mariolina Di

AU - Magnoni, Andrea

AU - Martinelli, Ottaviano

AU - Rigamonti, A.

AU - Salmaggi, Andrea

AU - Stanzani, Lorenzo

AU - Volpe, Cristina

AU - Zanotta, Nicoletta

AU - Zucca, Claudio

AU - Arienti, Flavio

AU - Arrigoni, Graziano Rocco

AU - Balestra, Giancarlo

AU - Ballabio, Piercarla

AU - Balossi, Stefano Marco

AU - Baratti, Maria Rita

AU - Barteselli, Fabrizia Enrica

AU - Bellani, Fausto

AU - Bellani, Mauro

AU - Bellini, Gianpiero

AU - Beretta, Pier Aldo

AU - Beretta, Roberto

AU - Bergamini, Massimo

AU - Bertella, Annalisa

AU - Bertolini, Francesco

AU - Bianchi, Marcellino

AU - Bigiolli, Patrizia

AU - Binda, Giuseppe

AU - Biondelli, Gigliola

AU - Bodega, Libero

AU - Bolis, Edoardo Giovanni

AU - Bolla, Marco Vincenzo Carlo

AU - Bonacina, Carlo Ambrogio

AU - Bonfanti, Marco

AU - Borghetti, Fausta

AU - Brambilla, Roberto

AU - Brancaleone, Wilma

AU - Brusadelli, Francesco

AU - Bub, Sabine

AU - Caccia, Giovanna

AU - Caglio, Myriam

AU - Rossi, Carlo Calvi

AU - Capra, Daniela

AU - Carone, Davide

AU - Carì, Giuseppe

AU - Carrera, Silvio

AU - Cavenago, Rosalia

AU - Cecchetti, Maria Luisa

AU - Centonze, Bice Antonella

AU - Cereghini, Fabio

AU - Cerrone, Ciro

AU - Ciappetta, Maria Pia

AU - Cogliati, Bruno

AU - Colombano, Ombretta

AU - Colombo, Alberto

AU - Colombo, Daniela

AU - Corti, Maria Lia

AU - Cremonini, Nicla

AU - Crippa, Marco

AU - Crippa, Rolando Antonio

AU - Crotta, Mario

AU - Curto, Salvatore

AU - Daielli, Patrizia

AU - De Gilio, Domenico

AU - De Pascalis, Giuseppe Pasquale

AU - Decet, Elena

AU - Morte, Luigi Della

AU - Duvia, Felice

AU - Favorito, Antonia

AU - Ferrario, Roberto

AU - Fezzi, Luigi

AU - Finzi, Angela Laura

AU - Fiorentino, Bruno Ugo

AU - Fornaciari, Agnese

AU - Franceschetti, S.

AU - Franceschetti, Silvana

AU - Fumagalli, Giovanni

AU - Fumagalli, Maurizio

AU - Galbiati, Giuseppe

AU - Galimberti, Carlo Andrea

AU - Ghiazza, Barbara

AU - Ghislanzoni, Paolo

AU - Gioffredi, Laura

AU - Hassibi, Taraneh

AU - Julita, Simone

AU - Leone, Giuseppe

AU - Levi, Claudio

AU - Locatelli, Giovanni

AU - Locati, A.

AU - Longhi, Enrico Giovanni

AU - Lukacova, Ingrid

AU - Manfroi, Mauro Giovanni

AU - Manzoni, Paola

AU - Marcolini, Claudio

AU - Minicucci, Fabio

AU - Martini, Mohammed Safwan

AU - Masperi, Rita

AU - Mayan, Sussele

AU - Mazzoleni, Valeria

AU - Menga, Antonio

AU - Merlini, Fiorella

AU - Messina, Enrico

AU - Micheli, Marta

AU - Micò, Rocco

AU - Millul, Andrea

AU - Montini, Barbara

AU - Palazzuolo, Alberto

AU - Panzeri, Silvano Primo

AU - Passoni, Giovanni

AU - Pensotti, Laura

AU - Petrone, Maria Marcella

AU - Pezzuto, Roberto

AU - Pigazzini, Elisabetta

AU - Pirovano, Nicoletta

AU - Pontiggia, Margherita

AU - Pozzi, Roberto

AU - Quadrelli, Carlo

AU - Rampello, Filomena

AU - Realini, Marco

AU - Righetti, Giovanni

AU - Ripa, Cesare

AU - Rivetta, Sonia

AU - Romeo, Antonino

AU - Rota, Carlo

AU - Rusconi, Tiziana

AU - Santarpia, Andrea

AU - Santi, Ivana

AU - Sciani, Luigi

AU - Scoccimarro, Gianni

AU - Scopinaro, Eugenio

AU - Semerano, Angelo Giuseppe

AU - Sferco, Daniela

AU - Sirtori, Anna Ersilia

AU - Spandri, Angela

AU - Spinelli, Bruno

AU - Stefanoni, Fausto

AU - Taiana, Raffaele

AU - Tamagnini, Libero

AU - Tassi, Laura

AU - Tentori, Giorgio

AU - Teodoro, Augusto

AU - Tinterova, Katerina

AU - Tocchetti, Ampelio

AU - Todeschini, Michela

AU - Trezza, Lorenzo

AU - Valsecchi, Valter

AU - Vanini, Roberto

AU - Vercelloni, Claudio Felice

AU - Villella, Anna

AU - Viola, Maria

AU - Vismara, Pietro

AU - Zoboli, Daniele Mario

AU - Bell, Gail

AU - Montesano, M.

AU - Romi, S.

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Background and purpose: Seizures in most people with epilepsy remit but prognostic markers are poorly understood. There is also little information on the long-term outcome of people who fail to achieve seizure control despite the use of two antiepileptic drugs (drug resistance). Methods: People with a validated diagnosis of epilepsy in whom two antiepileptic drugs had failed were identified from primary care records. All were registered with one of 123 family physicians in an area of northern Italy. Remission (uninterrupted seizure freedom lasting 2 years or longer) and prognostic patterns (early remission, late remission, remission followed by relapse, no remission) were determined. Results: In all, 747 individuals (381 men), aged 11 months to 94 years, were followed for 11 045.5 person-years. 428 (59%) were seizure-free. The probability of achieving 2-year remission was 18% at treatment start, 34% at 2 years, 45% at 5, 52% at 10 and 67% at 20 years (terminal remission, 60%). Epilepsy syndrome and drug resistance were the only independent predictors of 2- and 5-year remission. Early remission was seen in 101 people (19%), late remission in 175 (33%), remission followed by relapse in 85 (16%) and no remission in 166 (32%). Treatment response was the only variable associated with differing prognostic patterns. Conclusion: The long-term prognosis of epilepsy is favourable in most cases. Early seizure remission is not invariably followed by terminal remission and seizure outcome varies according to well-defined patterns. Prolonged seizure remission and prognostic patterns can be predicted by broad syndromic categories and the failure of two antiepileptic drugs.

AB - Background and purpose: Seizures in most people with epilepsy remit but prognostic markers are poorly understood. There is also little information on the long-term outcome of people who fail to achieve seizure control despite the use of two antiepileptic drugs (drug resistance). Methods: People with a validated diagnosis of epilepsy in whom two antiepileptic drugs had failed were identified from primary care records. All were registered with one of 123 family physicians in an area of northern Italy. Remission (uninterrupted seizure freedom lasting 2 years or longer) and prognostic patterns (early remission, late remission, remission followed by relapse, no remission) were determined. Results: In all, 747 individuals (381 men), aged 11 months to 94 years, were followed for 11 045.5 person-years. 428 (59%) were seizure-free. The probability of achieving 2-year remission was 18% at treatment start, 34% at 2 years, 45% at 5, 52% at 10 and 67% at 20 years (terminal remission, 60%). Epilepsy syndrome and drug resistance were the only independent predictors of 2- and 5-year remission. Early remission was seen in 101 people (19%), late remission in 175 (33%), remission followed by relapse in 85 (16%) and no remission in 166 (32%). Treatment response was the only variable associated with differing prognostic patterns. Conclusion: The long-term prognosis of epilepsy is favourable in most cases. Early seizure remission is not invariably followed by terminal remission and seizure outcome varies according to well-defined patterns. Prolonged seizure remission and prognostic patterns can be predicted by broad syndromic categories and the failure of two antiepileptic drugs.

KW - antiepileptic drug response

KW - chronic epilepsy

KW - drug resistance

KW - prognosis

KW - prognostic patterns

UR - http://www.scopus.com/inward/record.url?scp=84973340648&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84973340648&partnerID=8YFLogxK

U2 - 10.1111/ene.13005

DO - 10.1111/ene.13005

M3 - Article

SN - 1351-5101

VL - 23

SP - 1218

EP - 1227

JO - European Journal of Neurology

JF - European Journal of Neurology

IS - 7

ER -

Long-term prognosis of epilepsy, prognostic patterns and drug resistance: a population-based study

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