Remission in epilepsy: How long is enough?

Abstract:

OBJECTIVE:The International League Against Epilepsy (ILAE) has proposed to expand the definition of remission to 10 years seizure-free with the last 5 years off antiepileptic drugs (AEDs). We examined if a 10-year remission is needed to predict the lowest recurrence risk. METHODS:The population-based study cohort consisted of 148 patients with new-onset childhood epilepsy living in the catchment area of Turku University Hospital. They were prospectively followed for 44 years (median). Patients in first remission were prospectively followed for the duration of remission or possible relapse at 2 years in remission with the last year without antiepileptic drugs (AEDs), at 5 years in remission with the last 2 years without AEDs, and at 10 years with the last 5 years without AEDs. For comparison of the proportions of relapsed patients within each remission category exact Clopper Pearson 95% confidence intervals were used. RESULTS:The magnitude of the relapse rate estimates off AEDs did not significantly improve when remission increased from 2 years (2YR) to 5 years (5YR) and further to 10 years (10YR). However, 10YR was a more sensitive measure of no relapse than 2YR. Among patients with remission on or off AEDs, the ability to predict lower relapse rate increased markedly from 2 to 5 years, and again from 5 to 10 years. The risk of relapse was virtually the same estimated after 2YR off AEDs as after 10YR on or off AEDs, except for patients with generalized epilepsy whose 2YR off AEDs was a weaker predictor than 10YR on or off AEDs. SIGNIFICANCE:Given the modest differences in relapse rates between the 5 years seizure-free with last 2 years off medications definition and the 10 years seizure-free with last 5 years off medications, and the adverse impact of not being considered in remission, we propose that a return to the 5-year definition may be warranted.

journal_name

Epilepsia

journal_title

Epilepsia

authors

Sillanpää M,Schmidt D,Saarinen MM,Shinnar S

doi

10.1111/epi.13732

subject

Has Abstract

pub_date

2017-05-01 00:00:00

pages

901-906

issue

5

eissn

0013-9580

issn

1528-1167

journal_volume

58

pub_type

杂志文章
  • Subtle microscopic abnormalities in hippocampal sclerosis do not predict clinical features of temporal lobe epilepsy.

    abstract:PURPOSE:Subtle microdysplastic features are found in some patients with hippocampal sclerosis (HS) and refractory temporal lobe epilepsy. The significance of these findings is unknown. We investigated their frequency, relation to the pattern of HS, and clinical associations. METHODS:One-hundred forty patients with his...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.0013-9580.2004.57203.x

    authors: Kalnins RM,McIntosh A,Saling MM,Berkovic SF,Jackson GD,Briellmann RS

    更新日期:2004-08-01 00:00:00

  • Differential selectivity of several barbiturates on experimental seizures and neurotoxicity in the mouse.

    abstract::Six barbiturates with diverse time-action characteristics--thiopental, pentobarbital, butabarbital, phenobarbital, diphenylbarbiturate, and barbital--were evaluated for "anticonvulsant" and "neurotoxic" effects. For the former, the MES test, clonic seizures induced by pentylenetetrazol, 90 mg/kg, s.c., and maximal sei...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1157.1979.tb04783.x

    authors: Raines A,Blake GJ,Richardson B,Gilbert MB

    更新日期:1979-04-01 00:00:00

  • Effect of magnesium on epileptic foci.

    abstract::Parenteral magnesium sulfate has been used to control acute convulsions of diverse etiologies and is currently a mainstay in controlling eclamptic convulsions. However, the site of this anticonvulsant action has remained controversial and not well studied in experimental epileptic models. Therefore we determined the e...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1157.1978.tb05015.x

    authors: Borges LF,Gücer G

    更新日期:1978-02-01 00:00:00

  • Changes in quality of life after epilepsy surgery: the role of reprioritization response shift.

    abstract:OBJECTIVES:Health-related quality of life (HRQOL) is an important indicator of well-being in patients with epilepsy. When assessing changes in HRQOL over time, some of the changes observed may be due to the patients' change in the internal standards, value, or meaning that they attribute to the HRQOL domain being measu...

    journal_title:Epilepsia

    pub_type: 杂志文章,随机对照试验

    doi:10.1111/epi.12697

    authors: Sajobi TT,Fiest KM,Wiebe S

    更新日期:2014-09-01 00:00:00

  • Effect of anticonvulsants on cortical focal seizure in cats.

    abstract::Electrical stimulation of the visual cortex evoked the cortical focal seizure restricted in the neighbor cortex of the stimulated area in gallamine-immobilized cats. The present experiment was performed to clarify the participation of anticonvulsants in the cortex itself. Phenytoin and carbamazepine depressed the foca...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1157.1977.tb05588.x

    authors: Ito T,Hori M,Yoshida K,Shimizu M

    更新日期:1977-03-01 00:00:00

  • Genetic attribution and perceived impact of epilepsy in multiplex epilepsy families.

    abstract:OBJECTIVE:Studies have found that affected individuals who believe the cause of their disorder is genetic may react in various ways, including optimism for improved treatments and pessimism due to perceived permanence of the condition. This study assessed the psychosocial impact of genetic attribution among people with...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/epi.16352

    authors: Garofalo DC,Sorge ST,Hesdorffer DC,Winawer MR,Phelan JC,Chung WK,Ottman R

    更新日期:2019-11-01 00:00:00

  • Utility of genetic testing for therapeutic decision-making in adults with epilepsy.

    abstract:OBJECTIVE:Genetic testing has become a routine part of the diagnostic workup in children with early onset epilepsies. In the present study, we sought to investigate a cohort of adult patients with epilepsy, to determinate the diagnostic yield and explore the gain of personalized treatment approaches in adult patients. ...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/epi.16533

    authors: Johannesen KM,Nikanorova N,Marjanovic D,Pavbro A,Larsen LHG,Rubboli G,Møller RS

    更新日期:2020-06-01 00:00:00

  • Testing for minimal consciousness in complex partial and generalized tonic-clonic seizures.

    abstract::Impaired consciousness in epilepsy has a major negative impact on quality of life. Prior work suggests that complex partial seizures (CPS) and generalized tonic-clonic seizures (GTCS), which both cause loss of consciousness, affect similar frontoparietal networks. Milder involvement in CPS than in GTCS may spare some ...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1167.2012.03657.x

    authors: McPherson A,Rojas L,Bauerschmidt A,Ezeani CC,Yang L,Motelow JE,Farooque P,Detyniecki K,Giacino JT,Blumenfeld H

    更新日期:2012-10-01 00:00:00

  • Epileptiform EEG activities of the centromedian thalamic nuclei in patients with intractable partial motor, complex partial, and generalized seizures.

    abstract::Centromedian thalamic nuclei (CM) epileptiform EEG activities were recorded in patients with intractable partial motor, complex partial, and generalized seizures through implanted recording-stimulating electrodes, used for seizure control. CM epileptiform activities showed either little or no correlation to focal surf...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1157.1989.tb05301.x

    authors: Velasco M,Velasco F,Velasco AL,Luján M,Vázquez del Mercado J

    更新日期:1989-05-01 00:00:00

  • Mapping the gene for juvenile myoclonic epilepsy.

    abstract::The practice of epileptology at a molecular level, where gene products are identified by gene mapping, will soon be possible for a growing number of epilepsies. Juvenile myoclonic epilepsy (JME) is the first of such epilepsies to be mapped to a chromosome, namely chromosome 6p21.3. Family studies of 68 JME probands fr...

    journal_title:Epilepsia

    pub_type: 杂志文章,评审

    doi:10.1111/j.1528-1157.1989.tb05835.x

    authors: Delgado-Escueta AV,Greenberg DA,Treiman L,Liu A,Sparkes RS,Barbetti A,Park MS,Terasaki PI

    更新日期:1989-01-01 00:00:00

  • Oligodendrocyte lineage and myelination are compromised in the gray matter of focal cortical dysplasia type IIa.

    abstract:OBJECTIVES:Focal cortical dysplasias (FCDs) are local malformations of the human neocortex and a leading cause of medically intractable epilepsy. FCDs are characterized by local architectural disturbances of the neocortex and often by a blurred gray-white matter boundary indicating abnormal white matter myelination. We...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/epi.16415

    authors: Donkels C,Peters M,Fariña Núñez MT,Nakagawa JM,Kirsch M,Vlachos A,Scheiwe C,Schulze-Bonhage A,Prinz M,Beck J,Haas CA

    更新日期:2020-01-01 00:00:00

  • Effect of phenytoin on antibody production: use of a murine model.

    abstract::An animal model was used to study the effects of phenytoin on immune function. Inbred NFS mice, injected with phenytoin, 10-40 mg/kg, and immunized with bovine serum albumin (BSA), demonstrated a dose-dependent decrease in production of IgG antibodies to BSA. Phenytoin at the dosages used in this study did not appear ...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1157.1987.tb03627.x

    authors: Margaretten NC,Warren RP

    更新日期:1987-01-01 00:00:00

  • Ictal onset on intracranial EEG: Do we know it when we see it? State of the evidence.

    abstract:OBJECTIVE:A major limitation of intracranial electroencephalography (iEEG) is recording from a confined region. This may falsely localize seizure onset if the distinction between ictal onset zone, proximity, and spread is unclear, or if the ictal rhythm is not clearly identified. Delineation of the ictal onset zone is ...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/epi.13120

    authors: Singh S,Sandy S,Wiebe S

    更新日期:2015-10-01 00:00:00

  • Correlations between magnetic resonance imaging-based hippocampal sclerosis and depth electrode investigation in epilepsy of the mesiotemporal lobe.

    abstract::Quantitative analysis of hippocampal formations (HF) by magnetic resonance imaging (MRI) was correlated with depth electrode recordings in 18 patients with partial epilepsy. All had seizures of mesiotemporal origin. Electrodes explored three HF segments: amygdala and HF head and anterior and posterior HF body. Corresp...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1157.1994.tb02553.x

    authors: Baulac M,Saint-Hilaire JM,Adam C,Martinez M,Fontaine S,Laplane D

    更新日期:1994-09-01 00:00:00

  • Anesthestic agents and status epilepticus.

    abstract::There is little evidence to guide the choice of intravenous anesthetic agent to treat refractory status epilepticus but midazolam, propofol, and barbiturates are widely used. It is impractical to use inhalational anesthetic agents in most circumstances and there is little experience with non-GABA-ergic agents such as ...

    journal_title:Epilepsia

    pub_type: 杂志文章,评审

    doi:10.1111/j.1528-1167.2011.03234.x

    authors: Smith M

    更新日期:2011-10-01 00:00:00

  • Long-term increase in striatal thyrotropin-releasing hormone receptor binding caused by amygdaloid kindling.

    abstract::Our previous finding that intracerebroventricular (i.c.v.) administration of both thyrotropin-releasing hormone (TRH) and its analogue, gamma-butyrolactone-gamma-carbonyl-L-histidyl-L-prolinamide citrate (DN-1417), suppressed seizure development of amygdaloid (AM) kindling and kindled AM seizures leads to a new hypoth...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1157.1987.tb04212.x

    authors: Kajita S,Ogawa N,Sato M

    更新日期:1987-05-01 00:00:00

  • Temporal lobe epilepsy subtypes: differential patterns of cerebral perfusion on ictal SPECT.

    abstract:PURPOSE:We studied cerebral perfusion patterns in the various subtypes of TLE, as determined by pathology and good outcome after temporal lobectomy (as confirmation of temporal origin). METHODS:We studied clinical features and ictal technetium 99m hexamethyl-propyleneamineoxime (99mTc-HM-PAO) single-photon emission-co...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1157.1996.tb00653.x

    authors: Ho SS,Berkovic SF,McKay WJ,Kalnins RM,Bladin PF

    更新日期:1996-08-01 00:00:00

  • The clinical usefulness of ictal SPECT in temporal lobe epilepsy: the lateralization of seizure focus and correlation with EEG.

    abstract:PURPOSE:To analyze the relationship between ictal electroencephalography (EEG) and ictal single-photon emission computed tomography (SPECT) and to evaluate the diagnostic usefulness of ictal SPECT as an independent presurgical evaluation technique. METHODS:Sixty-eight patients with temporal lobe epilepsy who underwent...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1157.2000.tb00278.x

    authors: Lee SK,Lee SH,Kim SK,Lee DS,Kim H

    更新日期:2000-08-01 00:00:00

  • Mycoplasma pneumoniae-related postencephalitic epilepsy in children.

    abstract:PURPOSE:Mycoplasma pneumoniae, a common respiratory pathogen, has been implicated as an etiology of encephalitis, but there are few reports about it and postencephalitic epilepsy. This study aimed to investigate clinical factors, electroencephalography, and neuroradiologic features of M. pneumoniae-related encephalitis...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1167.2011.03218.x

    authors: Lin JJ,Hsia SH,Wu CT,Wang HS,Lin KL

    更新日期:2011-11-01 00:00:00

  • Is inpatient ictal video-electroencephalographic monitoring mandatory in mesial temporal lobe epilepsy with unilateral hippocampal sclerosis? A prospective study.

    abstract:OBJECTIVE:To compare surgical outcome in mesial temporal lobe epilepsy (MTLE) patients with unilateral hippocampal sclerosis (MTLE-HS) who had or did not have preoperative video-electroencephalographic monitoring (VEEG). METHODS:A prospective study was undertaken with 166 consecutive pharmacoresistant unilateral MTLE-...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/epi.13977

    authors: Alvim MKM,Morita ME,Yasuda CL,Damasceno BP,Lopes TM,Coan AC,Ghizoni E,Tedeschi H,Cendes F

    更新日期:2018-02-01 00:00:00

  • Lateralizing value of the auditory aura in partial seizures.

    abstract:PURPOSE:To describe the semiological features of auditory aura and to assess their possible lateralizing value in partial epilepsy. METHODS:Out of a series of 8,000 patients with epilepsy, we investigated 121 cases with partial seizures in whom auditory features were the first ictal symptom. According to the dominant ...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1167.2006.00881.x

    authors: Florindo I,Bisulli F,Pittau F,Naldi I,Striano P,Striano S,Michelucci R,Testoni S,Baruzzi A,Tinuper P

    更新日期:2006-01-01 00:00:00

  • Diagnostic utility of invasive EEG for epilepsy surgery: Indications, modalities, and techniques.

    abstract::Many patients with medically refractory epilepsy now undergo successful surgery based on noninvasive diagnostic information, but intracranial electroencephalography (IEEG) continues to be used as increasingly complex cases are considered surgical candidates. The indications for IEEG and the modalities employed vary ac...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/epi.13515

    authors: Jayakar P,Gotman J,Harvey AS,Palmini A,Tassi L,Schomer D,Dubeau F,Bartolomei F,Yu A,Kršek P,Velis D,Kahane P

    更新日期:2016-11-01 00:00:00

  • Absolute bioavailability of carbamazepine after oral administration of a 2% syrup.

    abstract::Two healthy male volunteers received 10 mg carbamazepine (CBZ) as a 2-h constant-rate intravenous (i.v.) infusion and 100 mg 15N-labeled CBZ as a 2% oral suspension, concomitantly. The two compounds have identical pharmacokinetics. Their respective concentrations in plasma were determined by gas chromatography-mass sp...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1157.1990.tb05384.x

    authors: Gérardin A,Dubois JP,Moppert J,Geller L

    更新日期:1990-05-01 00:00:00

  • MR spectroscopy shows reduced frontal lobe concentrations of N-acetyl aspartate in patients with juvenile myoclonic epilepsy.

    abstract:PURPOSE:Neuropsychological studies suggest frontal lobe dysfunctions in patients with juvenile myoclonic epilepsy (JME). In this study we investigated whether an underlying mechanism could be a regional neuronal damage not visible with structural magnetic resonance (MR), but detectable with magnetic resonance spectrosc...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1157.2000.tb00158.x

    authors: Savic I,Lekvall A,Greitz D,Helms G

    更新日期:2000-03-01 00:00:00

  • Microstructural and functional MRI studies of cognitive impairment in epilepsy.

    abstract::Cognitive impairment is the most common comorbidity in children with epilepsy, but its pathophysiology and predisposing conditions remain unknown. Clinical epilepsy characteristics are not conclusive in determining cognitive outcome. Because many children with epilepsy do not have macrostructural magnetic resonance im...

    journal_title:Epilepsia

    pub_type: 杂志文章,评审

    doi:10.1111/j.1528-1167.2012.03624.x

    authors: Braakman HM,van der Kruijs SJ,Vaessen MJ,Jansen JF,Debeij-van Hall MH,Vles JS,Aldenkamp AP,Backes WH,Hofman PA

    更新日期:2012-10-01 00:00:00

  • Excretion of valproic acid into semen of rabbits and man.

    abstract::Dipropylacetic acid (VPA, valproic acid) has been quantified in plasma and semen from rabbits and man using a new gas-liquid chromatographic assay. The drug assay is rapid, sensitive and free from interference by VPA metabolites. The beta phase half-life of VPA in rabbits after an i.v. dose (50 mg/kg) was 56 +/- 6 min...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1157.1978.tb05034.x

    authors: Swanson BN,Harland RC,Dickinson RG,Gerber N

    更新日期:1978-12-01 00:00:00

  • Hippocampal sclerosis and a second focal lesion--how often is it ipsilateral?

    abstract:PURPOSE:Hippocampal sclerosis (HS) is the most common pathologic finding in intractable temporal lobe epilepsy (TLE). In many patients, HS is accompanied by an extrahippocampal lesion (EHL). We sought to assess the lobar distribution and side of EHLs in relation to HS in a large consecutive series of patients presentin...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1167.2011.03021.x

    authors: Hofman PA,Fitt G,Mitchell LA,Jackson GD

    更新日期:2011-04-01 00:00:00

  • Altered behavior in experimental cortical dysplasia.

    abstract:PURPOSE:Developmental delay and cognitive impairment are common comorbidities in people with epilepsy associated with malformations of cortical development (MCDs). We studied cognition and behavior in an animal model of diffuse cortical dysplasia (CD), in utero irradiation, using a battery of behavioral tests for neuro...

    journal_title:Epilepsia

    pub_type: 杂志文章

    doi:10.1111/j.1528-1167.2011.03267.x

    authors: Zhou FW,Rani A,Martinez-Diaz H,Foster TC,Roper SN

    更新日期:2011-12-01 00:00:00

  • Effects of lamotrigine compared with levetiracetam on anger, hostility, and total mood in patients with partial epilepsy.

    abstract:PURPOSE:To assess anger/hostility during treatment with lamotrigine adjunctive therapy versus levetiracetam adjunctive therapy in patients with partial seizures. METHODS:This randomized, double-blind, parallel-group study in adults with partial seizures included an 8-week escalation phase, during which adjunctive lamo...

    journal_title:Epilepsia

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1111/j.1528-1167.2008.01792.x

    authors: Labiner DM,Ettinger AB,Fakhoury TA,Chung SS,Shneker B,Tatum Iv WO,Mitchell Miller J,Vuong A,Hammer AE,Messenheimer JA

    更新日期:2009-03-01 00:00:00

  • Clinical, functional, and neurophysiologic assessment of dysplastic cortical networks: Implications for cortical functioning and surgical management.

    abstract::Cortical malformations are highly epileptogenic lesions associated with complex, unanticipated, and often aberrant electrophysiologic and functional relationships. These relationships are inextricably linked to widespread cortical networks subserving eloquent functions, particularly language and motor ability. Cytomeg...

    journal_title:Epilepsia

    pub_type: 杂志文章,评审

    doi:10.1111/j.1528-1167.2009.02291.x

    authors: Duchowny M

    更新日期:2009-10-01 00:00:00