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Predictors of Unfavourable Seizure Outcome in Patients with Epilepsy in Nepal

Published online by Cambridge University Press:  02 December 2014

Subash Lohani ,
Upendra P. Devkota  and
Hemav Rajbhandari
Subash Lohani*
Affiliation:
National Institute of Neurological and Allied Sciences
Upendra P. Devkota
Affiliation:
National Institute of Neurological and Allied Sciences
Hemav Rajbhandari
Affiliation:
Nepal Epilepsy Association, Lazimpat, Kathmandu, Nepal
*
National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal.
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Abstract

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Background:

Despite optimal medical therapy, a sizeable number of patients continue to have persistent seizures. We evaluated the association of pretreatment and treatment variables with unfavorable seizure outcome.

Methods:

Patients with follow-up over 12 years in the Nepal Epilepsy Association were evaluated. Patients having seizures for at least a year and already on polytherapy after failure of two monotherapy trials were considered having unfavourable outcome. Variables under study were: age, sex, duration and frequency of seizures prior to treatment, type of seizure, neurological status, Computed Tomography (CT) finding, and failure of first anti-epileptic drug (AED). Bivariate analysis was done with Chi-square and Fisher exact tests. Potential interaction between variables was studied with a logistic regression analysis.

Results:

Out of a total 529 consecutive patients, 490 were included in the study. Unfavorable seizure outcome was seen in 26.8% of patients. Among 284 patients who remained viable for analysis, bivariate analysis showed significant association of unfavorable outcome with frequency of seizure (p 0.01), abnormal neurological status (p 0.01) and failure of first AED (p 0.00), while no significant association was seen with age at onset (p 0.45), sex (p 0.47), duration of seizure (p 0.43), type of seizure (p 0.12), and presence of CT abnormality (p 0.46). The fitted regression model portended an unfavorable prognosis with failure of first AED and abnormal neurological status, however, failed to show significant association with frequency of seizure.

Conclusions:

Failure of first AED trial and associated neurological deficits are significant predictors of unfavorable seizure outcome.

Résumé:

RÉSUMÉ:Contexte:

Un nombre appréciable de patients continue à présenter des crises malgré un traitement médical optimal. Nous avons évalué l’association entre certaines variables avant et après traitement chez les patients dont les crises n’étaient pas bien contrôlées.

Méthodes:

Nous avons évalué les patients de la Nepal Epilepsy Association qui étaient suivis depuis plus de 12 ans. Les patients qui avaient des crises depuis au moins un an et qui étaient déjà sous polythérapie suite à un échec d’au moins deux essais de monothérapie ont été considérés comme ayant un mauvais résultat. Nous avons étudié les variables suivantes : l’âge, le sexe, la durée et la fréquence des crises avant traitement, le type de crises, l’état neurologique, les constatations à la tomodensitométrie et l’échec du traitement par le premier médicament antiépileptique (MAE). Une analyse bivariée a été effectuée au moyen du chi–carré et du test de Fisher, et l’interaction entre les variables a été évaluée au moyen de l’analyse de régression logistique.

Résultats:

Quatre cent quatre–vingt–dix des 529 patients consécutifs ont été inclus dans l’étude. Une issue défavorable a été observée chez 26,8% des patients. Parmi les 284 patients analysables, l’analyse bivariée a montré une association significative entre une issue défavorable et la fréquence des crises (p = 0,01), un état neurologique anormal (p = 0,01) et un échec du premier MAE (p = 0,00). Aucune association significative n’a été observée avec l’âge de début ( p = 0,45), le sexe (p = 0,47), la durée des crises (p = 0,43), le type de crises (p = 0,12) et la présence d’anomalies à la tomodensitométrie (p = 0,46). Le modèle de régression ajusté qui prédisait un pronostic défavorable en présence d’un échec du premier MAE et d’un état neurologique anormal ne montrait cependant pas d’association significative avec la fréquence des crises.

Conclusions:

L’échec du traitement par le premier MAE et la présence de déficits neurologiques sont des facteurs qui prédisent une mauvaise réponde au traitement.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 1 , January 2010 , pp. 76 - 80
Copyright
Copyright © The Canadian Journal of Neurological 2010

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