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| ORIGINAL ARTICLE
|Year : 2018 | Volume
| Issue : 4 | Page : 1052--1059
Clinical predictors of treatment outcome in North Indian patients on antiepileptic drug therapy: A prospective observational study
Chitra Rawat1, Debleena Guin2, Puneet Talwar2, Sandeep Grover3, Ruchi Baghel2, Suman Kushwaha4, Sangeeta Sharma4, Rachna Agarwal4, Kiran Bala4, Achal K Srivastava5, Ritushree Kukreti2
1 Institute of Genomics and Integrative Biology (IGIB); Academy of Scientific and Innovative Research (AcSIR), Council of Scientific and Industrial Research (CSIR), New Delhi, India
2 Institute of Genomics and Integrative Biology (IGIB), New Delhi, India
3 Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Lübeck, Germany
4 Institute of Human Behavior and Allied Sciences (IHBAS), New Delhi, India
5 Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
Background: Nearly 40%–50% of the individuals fail to respond to first line antiepileptic drug (AED) monotherapy and 30% are refractory, which calls for the need to recognize predictive markers for treatment failure. This study aims to identify clinical factors predictive of a poor prognosis in patients on AED therapy.
Materials and Methods: A prospective follow-up study involving 1056 patients with epilepsy (PWE) aged 5–67 years from North India on phenytoin (PHT, n = 247), carbamazepine (CBZ, n = 369), valproate (VA, n = 271), phenobarbital (PB, n = 50), and multitherapy (MultiT, n = 119) was conducted between 2005 and 2015. Seizure and epilepsy types were diagnosed based on the classifications by the International League Against Epilepsy (ILAE). Patients remaining seizure-free during the past 1 year were assigned to the “no seizure” group and patients experiencing seizure recurrence were assigned to the “recurrent seizures” group.
Results: Of the total, 786 (74.4%) patients were successfully followed up with 60% achieving 1-year seizure remission. Seizure recurrence was observed in the remaining 40% of the patients with a high likelihood in patients with the disease onset at ≤5 years of age [55% vs. 38%, P = 0.0016, odds ratio (OR) = 2.02 (95% confidence interval (CI) = 1.31–3.13)], in patients with cryptogenic epilepsy than with idiopathic/symptomatic epilepsy (48% vs. 32%, P = 0.0049, OR = 1.61 [95% CI = 1.16–2.24]), and in patients with pretreatment seizure frequency ≥12/year (46% vs. 27%, P < 0.0001, OR = 2.21 [95% CI = 1.61–3.05]). Logistic regression analysis also revealed a significant association of seizure recurrence (P < 0.05) with the three variables.
Conclusion: Our findings suggest that an early disease onset, cryptogenic epilepsy, and a higher pretreatment seizure frequency are related to a poor prognosis or poor remission in people with epilepsy (PWE) on AED therapy.
Dr. Ritushree Kukreti
Genomics and Molecular Medicine Unit, Institute of Genomics and Integrative Biology (IGIB), Council of Scientific and Industrial Research (CSIR), Mall Road, New Delhi - 110 007
Source of Support: None, Conflict of Interest: None
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