Predictors of drug-resistant epilepsy among adult patients with epilepsy in tertiary referral hospital in Egypt

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-05-16 DOI:10.1016/j.jocn.2025.111312

Omar Amin EL Serafy , Nirmeen Adel Kishk , Amani M Nawito , Eman EL Far , Reham Mohamed Shamloul , Marwa EL Sayed EL Kotb , Aya Alsayyad , Ahmed Elsaid Elsayed , Enas Alsayyad

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引用次数: 0

Abstract

Background

About one-third of patients with epilepsy present with uncontrolled seizures. As a result, there is an increased risk of injury, psychological complications, and early death. Uncontrolled epilepsy most often stems from truly intractable seizures, or pseudo intractable seizures. Identifying true intractability is crucial for optimizing drug therapy.

Objectives

To identify the percentage of uncontrolled epilepsy in Kasr El-Ainy tertiary referral hospitals. Additionally, we aim to investigate the characteristics and predictors of true and pseudo intractability among the samples studied in tertiary referral hospitals.

Materials and methods

A hospital-based cross-sectional study performed over two stages. The primary stage identified the prevalence of uncontrolled seizures. The second stage compared a sample of patients with uncontrolled seizures, to those with good seizure control in terms of the clinical, neurophysiological, and radiological aspects.

Results

The point prevalence of uncontrolled epilepsy was 58.3 %. Among them, 24.2 % were truly intractable. In uncontrolled patients, a significantly higher percentage of patients with true drug-resistant epilepsy (DRE) showed positive consanguinity (p = 0.002), abnormal neurological examination (p = 0.027), interictal epileptic discharges (p = 0.03) and underlying structural lesions (p = 0.011) when compared to controls. The identified predictors for true DRE included younger age of onset (OR: 0.563), presence of neurological deficit (OR5.291) and use of three or more anti-seizure medication (ASM) (OR: 1.945).

Conclusion

The percentage of uncontrolled epilepsy in our tertiary care hospital is comparable to previous reports, with non-adherence being the major cause. Many variables may function as predictors for true DRE, which when considered, will aid in improving the management of patients with epilepsy.

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埃及三级转诊医院成人癫痫患者耐药癫痫的预测因素

背景：大约三分之一的癫痫患者出现不受控制的癫痫发作。因此，受伤、心理并发症和早期死亡的风险增加。不受控制的癫痫通常源于真正的难治性癫痫发作，或伪难治性癫痫发作。确定真正的难治性对于优化药物治疗至关重要。目的了解卡斯尔艾尼三级转诊医院未控制癫痫的比例。此外，我们的目的是调查在三级转诊医院研究的样本中真实和伪顽固性的特征和预测因素。材料和方法一项以医院为基础的横断面研究，分两个阶段进行。初级阶段确定了不受控制的癫痫发作的发生率。第二阶段比较癫痫发作不受控制的患者与癫痫发作控制良好的患者在临床、神经生理和放射学方面的差异。结果癫痫点患病率为58.3%。其中，确有难治性的占24.2%。在未控制的患者中，与对照组相比，真正耐药癫痫（DRE）患者的血亲关系呈阳性（p = 0.002），神经系统检查异常（p = 0.027），癫痫间期放电（p = 0.03）和潜在结构病变（p = 0.011）的比例明显更高。确定的预测因素包括发病年龄较小（OR: 0.563）、存在神经功能缺陷（OR: 5.291）和使用三种或三种以上抗癫痫药物（ASM）（OR: 1.945）。结论我院三级医院未控制癫痫的比例与以往报道相当，不依从是主要原因。许多变量可以作为真正的DRE的预测因子，当考虑到这一点时，将有助于改善癫痫患者的管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.