A major new international research initiative

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A major new international research initiative
EUCARE is a joint initiative of the ILAE
and IBE supported by an
unrestricted educational grant from UCB Pharma

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FONDE STUDY
Health burden
of epilepsy

• Around 5-10 of people will have a seizure at
  some time in their lives, 30 of whom will go on
  to develop epilepsy
• Thus 1 of the worlds population will have
  epilepsy at any given point in time, amounting to
  a total of 40 million
• 30-40 of people with epilepsy will have
  uncontrolled seizures accounting for over 80 of
  the overall cost
  
• This represents 1 of the Global Burden of
  Disease (WHO)
• and is equivalent to - breast cancer in women
  
• - lung cancer in
  men

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NEWLY DIAGNOSED EPILEPSY Epilepsy wheel of fortune
Vagal nerve stimulation
Intolerable side-effects
Seizure-free
Refractory
Surgery
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NEWLY DIAGNOSED EPILEPSY
Outcomes from July 1982 to May 2003
(N780)

• Responder seizure-free for a minimum of 12
  months
• Immediate responder no seizures after
  starting treatment
• Remission no relapse after becoming
  seizure-free
• Relapse controlled for at least one year then
  refractory
• Non-responder never seizure-free for any 12
  months

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NEWLY DIAGNOSED EPILEPSY
Categories of response to treatment
(N780)
Responders (64.6)
Mohanraj R, Brodie MJ. Eur J Neurol 2006 13
277-82
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NEWLY DIAGNOSED EPILEPSY
Remission rates according to age
Percentage
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85
n59 n131 n99 n87 n71 n56
n51 n36 n34 n35 n31 n19 n29 n23
n11 n8
Brodie MJ, Kwan P. Br Med J 20053311317-22
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OUTCOMES BY DURATION OF EPILEPSY PRIOR TO
STARTING TREATMENT
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NEWLY DIAGNOSED EPILEPSY
Predictors of refractoriness
(multivariate analysis)
Odds ratio 95 CI p
value Family history 1.89
1.15-3.00 0.011 Febrile seizures 3.36
1.58-7.18 0.002 Traumatic brain injury
3.26 1.59-4.69 lt0.001 Psychiatric
comorbidity 2.17 1.33-3.55
0.002 Recreational drug use 4.26
2.03-8.94 lt0.001 10 or more seizures
2.77 1.98-3.89 lt0.001
Hitiris N et al. Epilepsy Research 2007 75 192-6
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NEWLY DIAGNOSED EPILEPSY
Predictors of refractoriness
(multivariate analysis)
Odds ratio 95 CI p
value Family history 1.89
1.15-3.00 0.011 Febrile seizures 3.36
1.58-7.18 0.002 Traumatic brain injury
3.26 1.59-4.69 lt0.001 Psychiatric
comorbidity 2.17 1.33-3.55
0.002 Recreational drug use 4.26
2.03-8.94 lt0.001 10 or more seizures
2.77 1.98-3.89 lt0.001
Hitiris N et al. Epilepsy Research 2007 75 192-6
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NEWLY DIAGNOSED EPILEPSY
Follow up of 97 consecutive patients
undergoing antero-temporal
lobectomy

• A lifetime history of depression was the sole
  predictor of post-surgical auras (plt0.0001) in
  seizure-free patients
• A lifetime history of depression was also a
  predictor of disabling seizures with or without
  auras (p0.001).

Kanner AM et al, Neurology, submitted
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EPILEPSY MORTALITY
N SMR 95 CI p value Newly
diagnosed 890 1.42 1.16-1.72
p0.0007 Chronic epilepsy 2689 2.05
1.83-2.26 plt0.0001
No increase in risk was observed in patients who
were seizure-free
Mohanraj R et al Lancet Neurology 2006 5 481-7
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NEWLY DIAGNOSED EPILEPSY
Outcomes by syndromic classification
Mohanraj R, Brodie MJ. Eur J Neurol
200613277-82
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NEWLY DIAGNOSED EPILEPSY
Interictal EEG of a patient with juvenile
myoclonic epilepsy showing generalised multiple
spike-and-wave complexes
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NEWLY DIAGNOSED EPILEPSY Treatment response in
juvenile myoclonic epilepsies
(N55 25 population)

Mohanraj R, Brodie MJ. Acta Neurol Scand 2007
115 204-8