How long does it take for epilepsy to become intractable? A prospective investigation

摘要: Objective To determine prospectively when in the course of epilepsy intractability becomes apparent. Methods Data are from a prospective cohort 613 children followed for median 9.7 years. Epilepsy syndromes were grouped: focal, idiopathic, catastrophic, and other. Intractability was defined two ways: (1) 2 drugs failed, 1 seizure/month, on average, 18 months (stringent), (2) failure drugs. Delayed as 3 or more years after diagnosis. Results Eighty-three (13.8%) met stringent 142 (23.2%) two-drug definition. depended syndrome (p < 0.0001): 26 (31.3%) meeting 39 (27.5%) 2-drug definition had delayed intractability. often focal than catastrophic (stringent: 46.2 vs 14.3%, p = 0.003; two-drug: 40.3 2.2%, ≤ 0.0001). Early remission periods preceded 65.4 to 74.3% cases. After becoming intractable, 20.5% subsequently entered 13.3% seizure free at last contact. Interpretation Intractable may be delayed, especially epilepsy. It is by quiescent period, further remissions. These findings help explain why surgically treatable epilepsies take 20 longer before referral surgery. Ann Neurol 2006