Abstracts

A recent study in newly diagnosed epilepsy patients indicated that after failure of one AED due to lack of efficacy the likelihood of seizure control was 11%. No studies have been performed in adults that have become treatment refractory to determine if remission is possible. We wished to determine the likelihood of remission as well as any predictors of remission in patients that meet a strict definition of refractory epilepsy. From the 3224 charts at the University of Pennsylvania Epilepsy Center, we identified 246 patients followed from 2000 who met the following criteria: 1) were having at least one seizure per month and 2) had failed at least two antiepileptic drugs (AEDs) at the index date. Records were reviewed to identify baseline characteristics such as seizure type and frequency, duration of epilepsy, epilepsy syndrome, current AEDs, AEDs failed, presence of developmental delay, and history of status epilepticus. We used Kaplan Meier methods to estimate the rate of achieving a 6-month terminal seizure remission over the next three years and evaluated clinical predictors for seizure remission. Syndromes in the study population epilepsy included: localization related 80.5%, symptomatic generalized 11%, primary generalized 6.9% and other syndromes 1.6%. The median duration of follow up from index date was 3.10 years. The overall rate of 6-month terminal remission at 3 years was 15.5% (localization related: 16.7%, symptomatic generalized: 0%, and idiopathic generalized: 29.4%). Negative predictors for remission included a history of status epilepticus, the presence of mental retardation, and Lennox-Gastaut syndrome. Duration of epilepsy, age of onset, and number of AEDs failed were not predictors for remission.[figure1] In our refractory adult population there was a 5% per year remission rate, a frequency comparable to that shown in studies in children. Prospective studies with long term followup to refine these findings are needed.