How long does it take for epilepsy to become intractable? A prospective investigation
Objective To determine prospectively when in the course of epilepsy intractability becomes apparent. Methods Data are from a prospective cohort of 613 children followed for a median of 9.7 years. Epilepsy syndromes were grouped: focal, idiopathic, catastrophic, and other. Intractability was defined...
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| Veröffentlicht in: | Annals of neurology 2006-07, Vol.60 (1), p.73-79 |
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| container_title | Annals of neurology |
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| creator | Berg, Anne T. Vickrey, Barbara G. Testa, Francine M. Levy, Susan R. Shinnar, Shlomo DiMario, Frances Smith, Susan |
| description | Objective
To determine prospectively when in the course of epilepsy intractability becomes apparent.
Methods
Data are from a prospective cohort of 613 children followed for a median of 9.7 years. Epilepsy syndromes were grouped: focal, idiopathic, catastrophic, and other. Intractability was defined in two ways: (1) 2 drugs failed, 1 seizure/month, on average, for 18 months (stringent), and (2) failure of 2 drugs. Delayed intractability was defined as 3 or more years after epilepsy diagnosis.
Results
Eighty‐three children (13.8%) met the stringent and 142 (23.2%) met the two‐drug definition. Intractability depended on syndrome (p < 0.0001): 26 (31.3%) children meeting stringent and 39 (27.5%) meeting the 2‐drug definition had delayed intractability. Intractability was delayed more often in focal than catastrophic epilepsy (stringent: 46.2 vs 14.3%, p = 0.003; two‐drug: 40.3 vs 2.2%, p ≤ 0.0001). Early remission periods preceded delayed intractability in 65.4 to 74.3% of cases. After becoming intractable, 20.5% subsequently entered remission and 13.3% were seizure free at last contact.
Interpretation
Intractable epilepsy may be delayed, especially in focal epilepsy. It often is preceded by a quiescent period, followed by further remissions. These findings help explain why surgically treatable epilepsies may take 20 years or longer before referral to surgery. Ann Neurol 2006 |
| doi_str_mv | 10.1002/ana.20852 |
| format | Article |
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To determine prospectively when in the course of epilepsy intractability becomes apparent.
Methods
Data are from a prospective cohort of 613 children followed for a median of 9.7 years. Epilepsy syndromes were grouped: focal, idiopathic, catastrophic, and other. Intractability was defined in two ways: (1) 2 drugs failed, 1 seizure/month, on average, for 18 months (stringent), and (2) failure of 2 drugs. Delayed intractability was defined as 3 or more years after epilepsy diagnosis.
Results
Eighty‐three children (13.8%) met the stringent and 142 (23.2%) met the two‐drug definition. Intractability depended on syndrome (p < 0.0001): 26 (31.3%) children meeting stringent and 39 (27.5%) meeting the 2‐drug definition had delayed intractability. Intractability was delayed more often in focal than catastrophic epilepsy (stringent: 46.2 vs 14.3%, p = 0.003; two‐drug: 40.3 vs 2.2%, p ≤ 0.0001). Early remission periods preceded delayed intractability in 65.4 to 74.3% of cases. After becoming intractable, 20.5% subsequently entered remission and 13.3% were seizure free at last contact.
Interpretation
Intractable epilepsy may be delayed, especially in focal epilepsy. It often is preceded by a quiescent period, followed by further remissions. These findings help explain why surgically treatable epilepsies may take 20 years or longer before referral to surgery. Ann Neurol 2006</description><identifier>ISSN: 0364-5134</identifier><identifier>EISSN: 1531-8249</identifier><identifier>DOI: 10.1002/ana.20852</identifier><identifier>PMID: 16685695</identifier><identifier>CODEN: ANNED3</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Adolescent ; Age of Onset ; Anticonvulsants - therapeutic use ; Biological and medical sciences ; Child ; Child, Preschool ; Connecticut - epidemiology ; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases ; Drug Resistance ; Epilepsies, Partial - drug therapy ; Epilepsies, Partial - epidemiology ; Epilepsies, Partial - surgery ; Follow-Up Studies ; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy ; Humans ; Infant ; Infant, Newborn ; Medical Records ; Medical sciences ; Nervous system (semeiology, syndromes) ; Neurology ; Prospective Studies ; Remission Induction ; Risk Factors ; Time Factors ; Treatment Failure</subject><ispartof>Annals of neurology, 2006-07, Vol.60 (1), p.73-79</ispartof><rights>Copyright © 2006 American Neurological Association</rights><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3912-a559cf3dd979a439a5f02630dd1066444d13f52d33b1dc6ae7563f6b58d8cb1b3</citedby><cites>FETCH-LOGICAL-c3912-a559cf3dd979a439a5f02630dd1066444d13f52d33b1dc6ae7563f6b58d8cb1b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fana.20852$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fana.20852$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17944278$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16685695$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Berg, Anne T.</creatorcontrib><creatorcontrib>Vickrey, Barbara G.</creatorcontrib><creatorcontrib>Testa, Francine M.</creatorcontrib><creatorcontrib>Levy, Susan R.</creatorcontrib><creatorcontrib>Shinnar, Shlomo</creatorcontrib><creatorcontrib>DiMario, Frances</creatorcontrib><creatorcontrib>Smith, Susan</creatorcontrib><title>How long does it take for epilepsy to become intractable? A prospective investigation</title><title>Annals of neurology</title><addtitle>Ann Neurol</addtitle><description>Objective
To determine prospectively when in the course of epilepsy intractability becomes apparent.
Methods
Data are from a prospective cohort of 613 children followed for a median of 9.7 years. Epilepsy syndromes were grouped: focal, idiopathic, catastrophic, and other. Intractability was defined in two ways: (1) 2 drugs failed, 1 seizure/month, on average, for 18 months (stringent), and (2) failure of 2 drugs. Delayed intractability was defined as 3 or more years after epilepsy diagnosis.
Results
Eighty‐three children (13.8%) met the stringent and 142 (23.2%) met the two‐drug definition. Intractability depended on syndrome (p < 0.0001): 26 (31.3%) children meeting stringent and 39 (27.5%) meeting the 2‐drug definition had delayed intractability. Intractability was delayed more often in focal than catastrophic epilepsy (stringent: 46.2 vs 14.3%, p = 0.003; two‐drug: 40.3 vs 2.2%, p ≤ 0.0001). Early remission periods preceded delayed intractability in 65.4 to 74.3% of cases. After becoming intractable, 20.5% subsequently entered remission and 13.3% were seizure free at last contact.
Interpretation
Intractable epilepsy may be delayed, especially in focal epilepsy. It often is preceded by a quiescent period, followed by further remissions. These findings help explain why surgically treatable epilepsies may take 20 years or longer before referral to surgery. Ann Neurol 2006</description><subject>Adolescent</subject><subject>Age of Onset</subject><subject>Anticonvulsants - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Connecticut - epidemiology</subject><subject>Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases</subject><subject>Drug Resistance</subject><subject>Epilepsies, Partial - drug therapy</subject><subject>Epilepsies, Partial - epidemiology</subject><subject>Epilepsies, Partial - surgery</subject><subject>Follow-Up Studies</subject><subject>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Medical Records</subject><subject>Medical sciences</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Prospective Studies</subject><subject>Remission Induction</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Failure</subject><issn>0364-5134</issn><issn>1531-8249</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1P3DAQhq2Kqiy0B_4A8gWkHrLY8UfiU7VaFRYEtIeiSr1YE9tBLtk4xF5g_z2G3ZYTpznM8847ehA6oGRKCSlPoIdpSWpRfkATKhgt6pKrHTQhTPJCUMZ30V6MfwkhSlLyCe1SKWshlZigm0V4xF3ob7ENLmKfcII7h9swYjf4zg1xjVPAjTNh6bDv0wgmQdO5b3iGhzHEwZnkH15WDy4mfwvJh_4z-thCF92X7dxHN6fff80XxeWPs_P57LIwTNGyACGUaZm1qlLAmQLRklIyYi0lUnLOLWWtKC1jDbVGgquEZK1sRG1r09CG7aPjzd38yf0q9-ulj8Z1HfQurKKWdUUUZySDXzegyS_H0bV6GP0SxrWmRL841NmhfnWY2cPt0VWzdPaN3ErLwNEWgGiga0fojY9vXKU4L6s6cycb7jGLXL_fqGfXs3_VxSbhY3JP_xMw3mlZsUro39dn-ucfeiX4KdUX7BlpSJbK</recordid><startdate>200607</startdate><enddate>200607</enddate><creator>Berg, Anne T.</creator><creator>Vickrey, Barbara G.</creator><creator>Testa, Francine M.</creator><creator>Levy, Susan R.</creator><creator>Shinnar, Shlomo</creator><creator>DiMario, Frances</creator><creator>Smith, Susan</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><general>Willey-Liss</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200607</creationdate><title>How long does it take for epilepsy to become intractable? A prospective investigation</title><author>Berg, Anne T. ; Vickrey, Barbara G. ; Testa, Francine M. ; Levy, Susan R. ; Shinnar, Shlomo ; DiMario, Frances ; Smith, Susan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3912-a559cf3dd979a439a5f02630dd1066444d13f52d33b1dc6ae7563f6b58d8cb1b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Adolescent</topic><topic>Age of Onset</topic><topic>Anticonvulsants - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Connecticut - epidemiology</topic><topic>Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases</topic><topic>Drug Resistance</topic><topic>Epilepsies, Partial - drug therapy</topic><topic>Epilepsies, Partial - epidemiology</topic><topic>Epilepsies, Partial - surgery</topic><topic>Follow-Up Studies</topic><topic>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Medical Records</topic><topic>Medical sciences</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Prospective Studies</topic><topic>Remission Induction</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Failure</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Berg, Anne T.</creatorcontrib><creatorcontrib>Vickrey, Barbara G.</creatorcontrib><creatorcontrib>Testa, Francine M.</creatorcontrib><creatorcontrib>Levy, Susan R.</creatorcontrib><creatorcontrib>Shinnar, Shlomo</creatorcontrib><creatorcontrib>DiMario, Frances</creatorcontrib><creatorcontrib>Smith, Susan</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Berg, Anne T.</au><au>Vickrey, Barbara G.</au><au>Testa, Francine M.</au><au>Levy, Susan R.</au><au>Shinnar, Shlomo</au><au>DiMario, Frances</au><au>Smith, Susan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>How long does it take for epilepsy to become intractable? A prospective investigation</atitle><jtitle>Annals of neurology</jtitle><addtitle>Ann Neurol</addtitle><date>2006-07</date><risdate>2006</risdate><volume>60</volume><issue>1</issue><spage>73</spage><epage>79</epage><pages>73-79</pages><issn>0364-5134</issn><eissn>1531-8249</eissn><coden>ANNED3</coden><abstract>Objective
To determine prospectively when in the course of epilepsy intractability becomes apparent.
Methods
Data are from a prospective cohort of 613 children followed for a median of 9.7 years. Epilepsy syndromes were grouped: focal, idiopathic, catastrophic, and other. Intractability was defined in two ways: (1) 2 drugs failed, 1 seizure/month, on average, for 18 months (stringent), and (2) failure of 2 drugs. Delayed intractability was defined as 3 or more years after epilepsy diagnosis.
Results
Eighty‐three children (13.8%) met the stringent and 142 (23.2%) met the two‐drug definition. Intractability depended on syndrome (p < 0.0001): 26 (31.3%) children meeting stringent and 39 (27.5%) meeting the 2‐drug definition had delayed intractability. Intractability was delayed more often in focal than catastrophic epilepsy (stringent: 46.2 vs 14.3%, p = 0.003; two‐drug: 40.3 vs 2.2%, p ≤ 0.0001). Early remission periods preceded delayed intractability in 65.4 to 74.3% of cases. After becoming intractable, 20.5% subsequently entered remission and 13.3% were seizure free at last contact.
Interpretation
Intractable epilepsy may be delayed, especially in focal epilepsy. It often is preceded by a quiescent period, followed by further remissions. These findings help explain why surgically treatable epilepsies may take 20 years or longer before referral to surgery. Ann Neurol 2006</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>16685695</pmid><doi>10.1002/ana.20852</doi><tpages>7</tpages></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adolescent Age of Onset Anticonvulsants - therapeutic use Biological and medical sciences Child Child, Preschool Connecticut - epidemiology Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases Drug Resistance Epilepsies, Partial - drug therapy Epilepsies, Partial - epidemiology Epilepsies, Partial - surgery Follow-Up Studies Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Humans Infant Infant, Newborn Medical Records Medical sciences Nervous system (semeiology, syndromes) Neurology Prospective Studies Remission Induction Risk Factors Time Factors Treatment Failure |
| title | How long does it take for epilepsy to become intractable? A prospective investigation |
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