Prognostic patterns and predictors in epilepsy: a multicentre study (PRO-LONG).
epilepsy
long-term prognosis
prognostic patterns
prognostic predictors
Journal
Journal of neurology, neurosurgery, and psychiatry
ISSN: 1468-330X
Titre abrégé: J Neurol Neurosurg Psychiatry
Pays: England
ID NLM: 2985191R
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
27
03
2019
revised:
24
05
2019
accepted:
03
06
2019
pubmed:
30
6
2019
medline:
17
6
2020
entrez:
29
6
2019
Statut:
ppublish
Résumé
To describe the long-term prognosis of epilepsy and prognostic patterns in a large cohort of newly diagnosed patients and identify prognostic factors. Study participants were 13 Italian epilepsy centres with accessible records dating back to 2005 or earlier, complete data on seizure outcome and treatments, precise epilepsy diagnosis, and follow-up of at least 10 years. Records were examined by trained neurology residents for demographics, seizure characteristics, neurological signs, psychiatric comorbidity, first electroencephalogram (EEG) and MRI/CT, epilepsy type and aetiology, antiepileptic drugs (AEDs), and 1-year, 2-year, 5-year and 10-year seizure remissions. Five predefined prognostic patterns were identified: early remission, late remission, relapsing-remitting course, worsening course and no remission. Prognostic factors were assessed using multinomial logistic regression models. 1006 children and adults were followed for 17 892 person-years (median 16 years; range 10-57). During follow-up, 923 patients (91.7%) experienced 1-year remission. 2-year, 5-year and 10-year remissions were present in 89.5%, 77.1% and 44.4% of cases. 5-year remission was associated with one to two seizures at diagnosis, generalised epilepsy, no psychiatric comorbidity, and treatment with one or two AEDs during follow-up. 10-year remission was associated with one or two AEDs. The most common prognostic pattern was relapsing-remitting (52.2%), followed by early remission (24.5%). 8.3% of cases experienced no remission. Predictors of a relapsing-remitting course were <6 seizures at diagnosis, (presumed) genetic aetiology and no psychiatric comorbidity. Few seizures at diagnosis, generalised epilepsy and no psychiatric comorbidity predict early or late seizure freedom in epilepsy. Achieving remission at any time after the diagnosis does not exclude further relapses.
Identifiants
pubmed: 31248935
pii: jnnp-2019-320883
doi: 10.1136/jnnp-2019-320883
doi:
Substances chimiques
Anticonvulsants
0
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1276-1285Investigateurs
Romeo A
(R)
Lodi M
(L)
Viri M
(V)
Specchio L
(S)
Trivisano M
(T)
Mecarelli O
(M)
Zarabla A
(Z)
Capovilla G
(C)
Beccaria F
(B)
Sasanelli F
(S)
Galimberti Ca
(G)
Tartara E
(T)
Zamponi N
(Z)
Cappanera S
(C)
Aguglia U
(A)
Ferlazzo E
(F)
La Neve A
(N)
Luisi C
(L)
Pontrelli G
(P)
Basso P
(B)
Pozzi A
(P)
Cantisani At
(C)
Papetti R
(P)
De Maria G
(M)
Di Francesco J
(DF)
Albanese J
(A)
Informations de copyright
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: EB reports grants from UCB Pharma and from the Italian Ministry of Health. CF is a consultant of Biogen, Roche and OCM.