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Prognostic patterns and predictors in epilepsy: a multicentre study (PRO-LONG).

Abstract

OBJECTIVES

To describe the long-term prognosis of epilepsy and prognostic patterns in a large cohort of newly diagnosed patients and identify prognostic factors.

METHODS

Study participants were 13 Italian epilepsy centres with accessible records dating back to 2005 or earlier, complete data on seizure outcome and treatments, precise epilepsy diagnosis, and follow-up of at least 10 years. Records were examined by trained neurology residents for demographics, seizure characteristics, neurological signs, psychiatric comorbidity, first electroencephalogram (EEG) and MRI/CT, epilepsy type and aetiology, antiepileptic drugs (AEDs), and 1-year, 2-year, 5-year and 10-year seizure remissions. Five predefined prognostic patterns were identified: early remission, late remission, relapsing-remitting course, worsening course and no remission. Prognostic factors were assessed using multinomial logistic regression models.

RESULTS

1006 children and adults were followed for 17 892 person-years (median 16 years; range 10-57). During follow-up, 923 patients (91.7%) experienced 1-year remission. 2-year, 5-year and 10-year remissions were present in 89.5%, 77.1% and 44.4% of cases. 5-year remission was associated with one to two seizures at diagnosis, generalised epilepsy, no psychiatric comorbidity, and treatment with one or two AEDs during follow-up. 10-year remission was associated with one or two AEDs. The most common prognostic pattern was relapsing-remitting (52.2%), followed by early remission (24.5%). 8.3% of cases experienced no remission. Predictors of a relapsing-remitting course were <6 seizures at diagnosis, (presumed) genetic aetiology and no psychiatric comorbidity.

CONCLUSIONS

Few seizures at diagnosis, generalised epilepsy and no psychiatric comorbidity predict early or late seizure freedom in epilepsy. Achieving remission at any time after the diagnosis does not exclude further relapses.

Authors+Show Affiliations

Laboratory of Neurological Disorders, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy ettore.beghi@marionegri.it.Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy.Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy.Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy.Laboratory of Neurological Disorders, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy.Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy.Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy.Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy.Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy.Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy.Laboratory of Neurological Disorders, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.Medical and Surgical Sciences Department, School of Medicine, Magna Græcia University of Catanzaro, Viale Europa, Catanzaro, Italy. Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy.Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy.Epilepsy Center, Department of Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31248935

Citation

Beghi, Ettore, et al. "Prognostic Patterns and Predictors in Epilepsy: a Multicentre Study (PRO-LONG)." Journal of Neurology, Neurosurgery, and Psychiatry, 2019.
Beghi E, Beretta S, Carone D, et al. Prognostic patterns and predictors in epilepsy: a multicentre study (PRO-LONG). J Neurol Neurosurg Psychiatry. 2019.
Beghi, E., Beretta, S., Carone, D., Zanchi, C., Bianchi, E., Pirovano, M., ... Ferrarese, C. (2019). Prognostic patterns and predictors in epilepsy: a multicentre study (PRO-LONG). Journal of Neurology, Neurosurgery, and Psychiatry, doi:10.1136/jnnp-2019-320883.
Beghi E, et al. Prognostic Patterns and Predictors in Epilepsy: a Multicentre Study (PRO-LONG). J Neurol Neurosurg Psychiatry. 2019 Jun 27; PubMed PMID: 31248935.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic patterns and predictors in epilepsy: a multicentre study (PRO-LONG). AU - Beghi,Ettore, AU - Beretta,Simone, AU - Carone,Davide, AU - Zanchi,Clara, AU - Bianchi,Elisa, AU - Pirovano,Marta, AU - Trentini,Claudia, AU - Padovano,Giada, AU - Colombo,Matteo, AU - Cereda,Diletta, AU - Scanziani,Sofia, AU - Giussani,Giorgia, AU - Gasparini,Sara, AU - Bogliun,Graziella, AU - Ferrarese,Carlo, AU - ,, Y1 - 2019/06/27/ PY - 2019/03/27/received PY - 2019/05/24/revised PY - 2019/06/03/accepted PY - 2019/6/29/entrez PY - 2019/6/30/pubmed PY - 2019/6/30/medline KW - epilepsy KW - long-term prognosis KW - prognostic patterns KW - prognostic predictors JF - Journal of neurology, neurosurgery, and psychiatry JO - J. Neurol. Neurosurg. Psychiatry N2 - OBJECTIVES: To describe the long-term prognosis of epilepsy and prognostic patterns in a large cohort of newly diagnosed patients and identify prognostic factors. METHODS: Study participants were 13 Italian epilepsy centres with accessible records dating back to 2005 or earlier, complete data on seizure outcome and treatments, precise epilepsy diagnosis, and follow-up of at least 10 years. Records were examined by trained neurology residents for demographics, seizure characteristics, neurological signs, psychiatric comorbidity, first electroencephalogram (EEG) and MRI/CT, epilepsy type and aetiology, antiepileptic drugs (AEDs), and 1-year, 2-year, 5-year and 10-year seizure remissions. Five predefined prognostic patterns were identified: early remission, late remission, relapsing-remitting course, worsening course and no remission. Prognostic factors were assessed using multinomial logistic regression models. RESULTS: 1006 children and adults were followed for 17 892 person-years (median 16 years; range 10-57). During follow-up, 923 patients (91.7%) experienced 1-year remission. 2-year, 5-year and 10-year remissions were present in 89.5%, 77.1% and 44.4% of cases. 5-year remission was associated with one to two seizures at diagnosis, generalised epilepsy, no psychiatric comorbidity, and treatment with one or two AEDs during follow-up. 10-year remission was associated with one or two AEDs. The most common prognostic pattern was relapsing-remitting (52.2%), followed by early remission (24.5%). 8.3% of cases experienced no remission. Predictors of a relapsing-remitting course were <6 seizures at diagnosis, (presumed) genetic aetiology and no psychiatric comorbidity. CONCLUSIONS: Few seizures at diagnosis, generalised epilepsy and no psychiatric comorbidity predict early or late seizure freedom in epilepsy. Achieving remission at any time after the diagnosis does not exclude further relapses. SN - 1468-330X UR - https://www.unboundmedicine.com/medline/citation/31248935/Prognostic_patterns_and_predictors_in_epilepsy:_a_multicentre_study_(PRO-LONG) L2 - http://jnnp.bmj.com/cgi/pmidlookup?view=long&amp;pmid=31248935 DB - PRIME DP - Unbound Medicine ER -