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

Anne T. Berg, Barbara G. Vickrey, Francine M. Testa, Susan R. Levy, Shlomo Shinnar, Frances DiMario, Susan Smith

Research output: Contribution to journalArticle

137 Citations (Scopus)

Abstract

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

Original languageEnglish (US)
Pages (from-to)73-79
Number of pages7
JournalAnnals of Neurology
Volume60
Issue number1
DOIs
StatePublished - Jul 2006

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Epilepsy
Pharmaceutical Preparations
Partial Epilepsy
Seizures
Referral and Consultation

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Berg, A. T., Vickrey, B. G., Testa, F. M., Levy, S. R., Shinnar, S., DiMario, F., & Smith, S. (2006). How long does it take for epilepsy to become intractable? A prospective investigation. Annals of Neurology, 60(1), 73-79. https://doi.org/10.1002/ana.20852

How long does it take for epilepsy to become intractable? A prospective investigation. / Berg, Anne T.; Vickrey, Barbara G.; Testa, Francine M.; Levy, Susan R.; Shinnar, Shlomo; DiMario, Frances; Smith, Susan.

In: Annals of Neurology, Vol. 60, No. 1, 07.2006, p. 73-79.

Research output: Contribution to journalArticle

Berg, AT, Vickrey, BG, Testa, FM, Levy, SR, Shinnar, S, DiMario, F & Smith, S 2006, 'How long does it take for epilepsy to become intractable? A prospective investigation', Annals of Neurology, vol. 60, no. 1, pp. 73-79. https://doi.org/10.1002/ana.20852
Berg, Anne T. ; Vickrey, Barbara G. ; Testa, Francine M. ; Levy, Susan R. ; Shinnar, Shlomo ; DiMario, Frances ; Smith, Susan. / How long does it take for epilepsy to become intractable? A prospective investigation. In: Annals of Neurology. 2006 ; Vol. 60, No. 1. pp. 73-79.
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