Outcomes in newly diagnosed epilepsy in adolescents and adults: Insights across a generation in Scotland.

The outpatient services at the Epilepsy Unit in the Western Infirmary, Glasgow, Scotland was set up in September 1982. From the outset patient data were collected prospectively. A focused approach to patients with newly diagnosed epilepsy was developed and a series of 4 analyses have been undertaken over the intervening years, with results from the latest still being written up for publication. A total of 16 published papers have described patient outcomes over the years, focusing on response to different drug schedules. A number of factors contributing to a poorer prognosis has been identified and follow up data over 30 years has confirmed the lack of overall improvement in prognosis despite the introduction of 14 new AEDs for the common epilepsies in the UK with different mechanisms of action over this time. Patterns of response have confirmed that a majority of patients will go into remission with around 25% of the population appearing to have refractory epilepsy de novo. Since all available options are antiseizure and not antiepilepsy drugs, some patients, who are initially well controlled, are seen to relapse over time and to develop refractory epilepsy. A new approach in identifying and treating epileptogenesis is necessary, if this disappointing scenario is to be reversed with the next generation of antiepileptic drugs.