The probability of achieving remission after correction of therapy in patients with pharmacoresistant focal epilepsy
https://doi.org/10.30629/2658-7947-2023-28-3-36-43
Abstract
Drug-resistant forms of epilepsy are an important medical and social problem.
Goal of the work. Evaluation of the probability of achieving remission after correction of therapy in patients with drug-resistant focal epilepsy.
Material and methods. The study included 309 patients divided into three heterogeneous groups: a group of patients with focal pharmacoresistant epilepsy; a group of patients with super refractory focal epilepsy; control group – patients who had not previously received treatment. The examination included history taking, clinical and neurological examination, routine EEG and/or EEG video monitoring, MRI of the brain, and analysis of medical records. Therapy was adjusted.
Results. After correction of therapy, remission in patients in Group 1 was achieved in 27.8% of patients, improvement – in 27.1%, no effect – in 45.1%; in Group 2, remission was achieved in 13.2% of patients, improvement – in 28.6%, no effect – in 58.2%; in Group 3, remission was achieved in 41.2% of patients, improvement – in 32.9%, no effect – in 25.9%. Negative prognostic factors did not show a significant correlation with the lack of effect of therapy.
Conclusion. After correction of therapy, remission was achieved in several patients with drug-resistant focal epilepsy, while negative prognostic factors do not exclude the possibility of achieving remission.
About the Authors
K. V. Firsov
M. F. Vladimirsky Moscow Regional Research and Clinical Institute (MONIKI)
Russian Federation
Russian Federation
Konstantin V. Firsov
Moscow
A. S. Kotov
M. F. Vladimirsky Moscow Regional Research and Clinical Institute (MONIKI)
Russian Federation
Russian Federation
Moscow
M. G. Amirchanyan
M. F. Vladimirsky Moscow Regional Research and Clinical Institute (MONIKI)
Russian Federation
Russian Federation
Moscow
References
1. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475–82. https://doi.org/10.1111/epi.12550
2. Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):522–530. https://doi.org/10.1111/epi.13670
3. Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classifi cation and Terminology. Epilepsia. 2017;58(4):512–521. https://doi.org/10.1111/epi.13709
4. Wirrell EC, Nabbout R, Scheffer IE, Alsaadi T, Bogacz A, French JA et al. Methodology for classification and definition of epilepsy syndromes with list of syndromes: Report of the ILAE Task Force on Nosology and Definitions. Epilepsia. 2022;63(6):1333–1348. https://doi.org/10.1111/epi.17237
5. Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51(6):1069–77. https://doi:10.1111/j.1528-1167.2009.02397.x
6. Ermolaev OY. Mathematical statistics for psychologists. 7th ed. stereotyped. M.: FLINTA, 2019:336 p. (In Russ.)]. URL: https://www.rosmedlib.ru/book/ISBN9785976519176.html (дата обращения: 20.01.2023).
7. Avakyan GN, Blinov DV, Alikhanov AA, Perepelova EM, Perepelov VA, Burd SG et al. Russian League Against Epilepsy recommendations for the use of structural magnetic resonance imaging in the diagnosis of epilepsy. Epilepsia i paroksizmalʹnye sostoania/Epilepsy and Paroxysmal Conditions. 2019;11(3):208–232. (In Russ.)]. https://doi:10.17749/2077-8333.2019.11.3.208-232
8. Shinnar S, Berg AT, Moshé SL, Kang H, O’Dell C, Alemany M et al. Discontinuing antiepileptic drugs in children with epilepsy: a prospective study. Ann Neurol. 1994;35(5):534–45. https://doi:10.1002/ana.410350506
9. Peters AC, Brouwer OF, Geerts AT, Arts WF, Stroink H, van Donselaar CA. Randomized prospective study of early discontinuation of antiepileptic drugs in children with epilepsy. Neurology. 1998;50(3):724–30. https://doi:10.1212/wnl.50.3.724
10. Kotov AS, Rudakova IG, Belova YuA. Predictors of the effectiveness of treatment of symptomatic and cryptogenic partial epilepsy in adults. Almanac of Clinical Medicine. (Al`manah klinicheskoj mediciny). 2006;13:49–54. (In Russ.) URL:https://cyberleninka.ru/article/n/prediktory-effektivnostilecheniya-simptomaticheskih-i-kriptogennyh-partsialnyh-epilepsiy-u-vzroslyh/viewer (дата обращения: 20.01.2023).
11. Sillanpää M. Remission of seizures and predictors of intractability in long-term follow-up. Epilepsia. 1993;34(5):930–6. https://doi:10.1111/j.1528-1157.1993.tb02114.x
12. Cockerell OC, Johnson AL, Sander JW, Hart YM, Shorvon SD. Remission of epilepsy: results from the National General Practice Study of Epilepsy. Lancet. 1995;346(8968):140–4. https://doi:10.1016/s0140-6736(95)91208-8.
13. MacDonald BK, Johnson AL, Goodridge DM, Cockerell OC, Sander JW, Shorvon SD. Factors predicting prognosis of epilepsy after presentation with seizures. Ann Neurol. 2000;48(6):833–41. Erratum in: Ann Neurol 2001;49(4):547. Erratum in: Ann Neurol 2001;50(6):830. PMID: 11117539.
14. Mohanraj R, Brodie MJ. Outcomes in newly diagnosed localization-related epilepsies. Seizure. 2005;14(5):318–23. https://doi:10.1016/j.seizure.2005.04.002
15. Cendes F. Neuroimaging predictors of AED resistance in new-onset epilepsies. Epilepsia. 2011;52 Suppl 4:7–9. https://doi:10.1111/j.1528-1167.2011.03143.x
16. Kotov AS, Rudakova IG, Kotov SV. Initial injury and symptomatic focal epilepsy. Journal of Neurology and Psychiatry named after C.C. Korsakov (Zhurnal nevrologii i psixiatrii im. C.C. Korsakova). 2009;109(9):12–15. (In Russ.)]. https://studfile.net/preview/6748723/ (дата обращения: 20.01.2023).
17. Mohanraj R, Brodie MJ. Early predictors of outcome in newly diagnosed epilepsy. Seizure. 2013;22(5):333–44. https://doi:10.1016/j.seizure.2013.02.002
18. Beghi E, Giussani G, Sander JW. The natural history and prognosis of epilepsy. Epileptic Disord. 2015;17(3):243–53. https://doi:10.1684/epd.2015.0751
19. Dlugos DJ, Sammel MD, Strom BL, Farrar JT. Response to fi rst drug trial predicts outcome in childhood temporal lobe epilepsy. Neurology. 2001;57(12):2259–64. https://doi:10.1212/wnl.57.12.2259
20. Kwan P, Brodie MJ. Effectiveness of first antiepileptic drug. Epilepsia. 2001;42(10):1255–60. https://doi:10.1046/j.1528-1157.2001.04501.x
21. Firsov KV, Amirhanyan MG, Kotov AS. Is it possible to predict the treatment efficacy in adult patients with focal epilepsy? Epilepsy and Paroxysmal Conditions (Epilepsia i paroksizmalʹnye sostoania). 2019;11(4):312–320. (In Russ.) https://doi.org/10.17749/2077-8333.2019.11.4.312-320
Review
For citations:
Firsov K.V., Kotov A.S., Amirchanyan M.G. The probability of achieving remission after correction of therapy in patients with pharmacoresistant focal epilepsy. Russian neurological journal. 2023;28(3):36-43. (In Russ.) https://doi.org/10.30629/2658-7947-2023-28-3-36-43
Views:
348
Email this article 