Abstracts

Rationale: Data from epidemiological studies of epilepsy are important as they describe the distribution and burden of illness on individuals. Longitudinal studies of diagnosed epilepsy have identified prognostic factors that allow early identification of patients whose seizures are likely to remain uncontrolled with antiepileptic medication. Our purpose is to investigate the clinical characteristic and prognosis of 685 patients with epilepsy and also to identify predictive factors of the outcome by analyzing a community-based cohort of patients over a 10-year period. Methods: This is a longitudinal, retrospective study of community-based cohort of 685 patients with diagnosed epilepsy. 582 were followed over 10 years (1990-2007). The province of Alicante is one of the three provinces of the Valencia region (Spain). University General Hospital of Alicante is a referral center for neurological diseases. The following were considered variables of this study: age at onset of epilepsy, sex, marital status and socioeconomic status, type of epileptic seizures, date of first epileptic episode, date of first visit and last visit, date of initial antiepileptic drugs (AEDs), type of treatment, treatment response, adherence to treatment, and duration of the disease. Cause and date of death. Information of the death was obtained through the family. Results: Out of 685 patients, only 582 patients completed the study (103 patients were lost due to not attending the medical appointments or decease). The average age of the group is 36 years old. There is no significative difference in terms of gender. 53.9% of the epileptic patients are single. 54.9% of the epileptic patients turn up to have uncontrolled episodes with monotherapy in initial stages. The percentage of well-controlled is 80%. These significantly vary throughout time (p<0.001). In the last visit, the percentage of well-controlled patients is 79.4% without any significant variation in comparison to the first year of treatment (p=0.627). During the study, 532 patients (91.4%) have been well controlled at some point. The presence of secondary focal generalized episodes is a resistance risk factor to drugs with OR=1,988 [IC₉₅=(1,105; 3,577)]. The number of AED is a resistance risk factor to drugs with OR=7,532 [IC₉₅=5,214; 10,881)]. Conclusions: This study suggests a link between the type of crisis and the number of AEDs prescribed until all epileptic episodes are controlled (regardless of the age when the epileptic episodes appeared, the diagnosed elapsed time or the AED action mechanisms). Also shows that the early response to treatment is a powerful predictor of the long-term outlook of newly diagnosed epilepsy. Patients who do not achieve complete seizure control with the first appropriate regimens of AEDs after starting treatment, have a relatively small chance of achieving seizure freedom with further pharmacotherapy and may be considered to have drug-resistant epilepsy. The high percentage of single patients states an evident negative influence of epilepsy in the civil stage of the patients.