Prognosis of epilepsy: a review and further analysis of the first nine years
of the British National General Practice Study of Epilepsy, a prospective population-based
study
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Medline Identifier??
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97176643??
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Authors
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Cockerell OC. Johnson AL. Sander JW. Shorvon SD.
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Institution
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Epilepsy Research Group, National Hospital for Neurology and Neurosurgery,
London, England.
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Title
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Prognosis of epilepsy: a review and further analysis of the first nine years
of the British National General Practice Study of Epilepsy, a prospective population-based
study
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Local Messages
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Held at BMA Library
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Source
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Epilepsia. 38(1):31-46, 1997 Jan.
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Abstract
PURPOSE: To understand the prognosis of newly diagnosed epilepsy to
provide rational therapy and advice for patients and their physicians.
METHODS: The National General Practice Study of Epilepsy (NGPSE) is the
first large population-based study that has assessed the prognosis of patients
with newly diagnosed epilepsy prospectively over a prolonged period. We review
the previously published data on the prognosis of epilepsy after 9 years of follow-up.
One thousand ninety-one patients with newly diagnosed or suspected epilepsy who
were attending 1 of 275 general practices throughout the United Kingdom between
1984 and 1987 were ascertained. Cases in this study were defined as the occurrence
of one or more seizures, including provoked seizures. Prognosis in terms of remission
of seizures, and mortality, was analyzed in the patients who were classified 6
months after recruitment as having definite epilepsy (n = 564) or possible/probable
epilepsy (n = 228).
RESULTS: Only 33 patients were completely lost to follow-up. After 9 years,
86% [95% confidence interval (CI) 81, 90] of patients with definite epilepsy had
achieved a remission of 3 years, and 68% (CI 61, 75), had achieved a remission
of 5 years. For the complete cohort, with possible/probable epilepsy included,
the rates increased to 87% (CI 83, 91) for 3-year remission and 71% (CI 65, 77)
for 5-year remission. The proportion of patients with definite epilepsy who were
still in remission at 9-year follow-up (terminal remission) was 68% (CI 62, 74)
for 3-year remission and 54% (CI 48, 60) for 5-year remission. When stratified
by etiology, the proportions achieving 5-year remission by 9 years was 69% (CI
60, 77) for idiopathic seizures, and 61% (CI 46, 75) for remote symptomatic epilepsy.
Age and seizure type had small effects on the chances of achieving remission,
with children experiencing slightly lower rates than older patients, and partial
seizures having lower remission rates than generalized seizures. The overall standardized
mortality ratio (SMR) for patients with definite or possible/probable epilepsy
was 2.5 (CI 2.1, 2.9), and 3.0 (CI 2.5, 3.7) for patients who were classified
as having definite epilepsy. The SMR for patients with idiopathic epilepsy was
1.6 (CI 1.0, 2.4), for those with remote symptomatic epilepsy it was 4.3 (CI 3.3,
5.5), and for those with acute symptomatic epilepsy it was 2.9 (CI 1.7, 4.5).
CONCLUSIONS: Overall, most patients with epilepsy will enter remission; however,
there is a higher than expected risk of death, especially in those with symptomatic
epilepsy.
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