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

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.