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Epilepsy diagnostic and treatment needs identified with a collaborative database involving tertiary centers in France
Author(s) -
Chipaux Mathilde,
Szurhaj William,
Vercueil Laurent,
Milh Mathieu,
Villeneuve Nathalie,
Cances Claude,
Auvin Stéphane,
Chassag Serge,
Napuri Sylvia,
Allaire Catherine,
Derambure Philippe,
Marchal Cécile,
Caubel Isabelle,
RicardMousnier Brigitte,
N'Guyen the Tich Sylvie,
Pinard JeanMarc,
BahiBuisson Nadia,
Baracé Claire,
Kahane Philippe,
Gautier Agnès,
Hamelin Sophie,
CosteZeitoun Delphine,
Rosenberg SarahDominique,
Clerson Pierre,
Nabbout Rima,
Kuchenbuch Mathieu,
Picot MarieChristine,
Kaminska Anna
Publication year - 2016
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13368
Subject(s) - epilepsy , hippocampal sclerosis , drug resistant epilepsy , cortical dysplasia , etiology , temporal lobe , pediatrics , medicine , epilepsy syndromes , age of onset , psychiatry , disease
Summary Objective To obtain perspective on epilepsy in patients referred to tertiary centers in France, and describe etiology, epilepsy syndromes, and identify factors of drug resistance and comorbidities. Methods We performed a cross‐sectional analysis of the characteristics of 5,794 pediatric and adult patients with epilepsy included in a collaborative database in France between 2007 and 2013. Comparisons between groups used Student's t ‐test or Fisher's exact test for binary or categorical variables. Factors associated with drug resistance and intellectual disability were evaluated in multi‐adjusted logistic regression models. Results Mean age at inclusion was 17.9 years; children accounted for 67%. Epilepsy was unclassified in 20% of patients, and etiology was unknown in 65%, including those with idiopathic epilepsies. Etiologies differed significantly in adult‐ when compared to pediatric‐onset epilepsy; however, among focal structural epilepsies, mesial temporal lobe epilepsy with hippocampal sclerosis began as often in the pediatric as in adult age range. Drug resistance concerned 53% of 4,210 patients evaluable for seizure control and was highest in progressive myoclonic epilepsy (89%), metabolic diseases (84%), focal cortical dysplasia (70%), other cortical malformations (69%), and mesial temporal lobe epilepsy with hippocampal sclerosis (67%). Fifty‐nine percent of patients with focal structural epilepsy and 69% with epileptic encephalopathies were drug resistant; however, 40–50% of patients with West syndrome and epileptic encephalopathy with continuous spike‐and‐waves during sleep were seizure‐free. Ages at onset in infancy and in young adults shared the highest risk of drug resistance. Epilepsy onset in infancy comprised the highest risk of intellectual disability, whereas specific cognitive impairment affected 36% of children with idiopathic focal epilepsy. Significance Our study provides a snapshot on epilepsy in patients referred to tertiary centers and discloses needs for diagnosis and treatment. Large databases help identify patients with rare conditions that could benefit from specific prospective studies.