Ayman Ashmawi1, Hassan Hosny2, Ahmed Abdelalim3, Elisa Bianchi4, Ettore Beghi5. 1. Epiclue Epilepsy Clinic, Cairo, Egypt. Electronic address: aymaneuro@hotmail.com. 2. Epiclue Epilepsy Clinic, Cairo, Egypt; Department of Neurology, Cairo University, Egypt. Electronic address: drhassanhosny@yahoo.com. 3. Department of Neurology, Cairo University, Egypt. Electronic address: a.aalim@kasralainy.edu.eg. 4. IRCCS - Istituto Mario Negri, Milano, Italy. Electronic address: elisa.bianchi@marionegri.it. 5. IRCCS - Istituto Mario Negri, Milano, Italy. Electronic address: ettore.beghi@marionegri.it.
Abstract
PURPOSE: To investigate the long-term prognosis and prognostic patterns of epilepsy in a single practice study from a developing country. METHODS: Consecutive patients first seen in an epilepsy clinic in Cairo, Egypt between January 1994 and December 2009 with at least 4 years of follow-up were included. Demographic, clinical, EEG and imaging findings at diagnosis were recorded. At follow-up, treatment was adjusted as clinically indicated. The response to the first drug was defined as 6-month seizure remission. Outcome measures included 2-year remission (R) and 2-year sustained remission (SR). Prognostic patterns were early (ER) and late remission (LR), relapsing-remitting (RR) course, worsening course (WC) and no remission. RESULTS: Included were 287 patients aged 1-66 years and followed for 2237.0 person-years (mean 7.8 years). 244 (85%) attained 2-year R. The cumulative time dependent probability of R was 86.7% at 10 years. Only the response to the first drug predicted R. 82 (28.6%) attained 2-year SR. The probability of SR was 40.9% at 10 years. Poor treatment response and nocturnal seizures predicted lowered SR. R and SR were inversely correlated to the number of drugs. 208 patients (72.5%) entered ER, 36 (12.5%) entered LR, 138 (48.1%) had RR course. A WC was present in 24 (8.4%), 43 (15.0%) never entered remission. Prognostic patterns varied with neurological examination, MRI findings, pre-treatment seizure frequency, seizure type, number of seizure types, etiology, syndrome and response to first drug. CONCLUSIONS: The long-term prognosis of newly diagnosed epilepsy patients from a developing country is in keeping with published reports.
PURPOSE: To investigate the long-term prognosis and prognostic patterns of epilepsy in a single practice study from a developing country. METHODS: Consecutive patients first seen in an epilepsy clinic in Cairo, Egypt between January 1994 and December 2009 with at least 4 years of follow-up were included. Demographic, clinical, EEG and imaging findings at diagnosis were recorded. At follow-up, treatment was adjusted as clinically indicated. The response to the first drug was defined as 6-month seizure remission. Outcome measures included 2-year remission (R) and 2-year sustained remission (SR). Prognostic patterns were early (ER) and late remission (LR), relapsing-remitting (RR) course, worsening course (WC) and no remission. RESULTS: Included were 287 patients aged 1-66 years and followed for 2237.0 person-years (mean 7.8 years). 244 (85%) attained 2-year R. The cumulative time dependent probability of R was 86.7% at 10 years. Only the response to the first drug predicted R. 82 (28.6%) attained 2-year SR. The probability of SR was 40.9% at 10 years. Poor treatment response and nocturnal seizures predicted lowered SR. R and SR were inversely correlated to the number of drugs. 208 patients (72.5%) entered ER, 36 (12.5%) entered LR, 138 (48.1%) had RR course. A WC was present in 24 (8.4%), 43 (15.0%) never entered remission. Prognostic patterns varied with neurological examination, MRI findings, pre-treatment seizure frequency, seizure type, number of seizure types, etiology, syndrome and response to first drug. CONCLUSIONS: The long-term prognosis of newly diagnosed epilepsypatients from a developing country is in keeping with published reports.