A Population-Based Study on the Long-Term Prognosis of Epilepsy, Prognostic Patterns and Drug Resistance (P1.103)

Objective: To better understand prognostic patterns and elucidate the long-term outcome of people with epilepsy who fail to achieve seizure control despite the use of two or more antiepileptic drugs (drug resistance). Background: The long-term prognosis of epilepsy is characterized by differing patterns but the effects of treatment on these patterns is unknown. Methods: Between January 2000 and December 2008 we identified from primary care records people with a validated diagnosis of epilepsy. All were registered with one of 123 general practitioners in an area of Northern Italy. For each eligible case, data were collected on demographics, seizure type(s), disease duration, epilepsy syndrome, number and type of drugs (with drug schedules). We determined remission (uninterrupted seizure freedom lasting 2 years or longer) and prognostic patterns (early remission, late remission, remission followed by relapse, no remission). Results: 747 individuals (381 men), aged 11 months to 94 years, were followed for 11,045.5 person-years. At the end of the study period 428 (59[percnt]) were seizure-free. The probability of starting 2-year remission was 18[percnt] at treatment start, 34[percnt] at two years, 45[percnt] at five, 52[percnt] at ten and 67[percnt] at 20 years (terminal remission, 60[percnt]). Epilepsy syndrome and drug resistance were the only independent predictors of 2- and 5-year remission. Early remission was seen in 101 people (19[percnt]), late remission in 175 (33[percnt]), remission followed by relapse in 85 (16[percnt]), and no remission in 166 (32[percnt]). Treatment response was the only variable associated with differing prognostic patterns. Conclusions: The long-term prognosis of epilepsy is favorable in most cases. Early seizure remission is not invariably followed by terminal remission and seizure outcome varies according to well-defined patterns. Epilepsy syndrome and the response to two drugs predict prolonged seizure remission while treatment response also predicts prognostic patterns. Disclosure: Dr. Beghi has received personal compensation for activities with UCB-Pharma, Shire as an advisory board member. Dr. Giussani has nothing to disclose. Dr. Canelli has nothing to disclose. Dr. Bianchi has nothing to disclose. Dr. Erba has nothing to disclose. Dr. Franchi has nothing to disclose. Dr. Nobili has nothing to disclose. Dr. Sander has received research support from from UCB Pharmaceuticals, Eisai Inc., and Pfizer.