The contribution of tertiary centers to the quality of the diagnosis and treatment of epilepsy. Osservatorio Regionale per l'Epilessia (OREp), Lombardy.

PURPOSE

A survey was made of a network of 14 epilepsy centers in Italy to assess whether integrated diagnosis and treatment monitoring led to a more precise syndromic classification of the patients and a better response to treatment.

METHODS

Data on the diagnosis and treatment of epilepsy and the degree of seizure control were recorded in a register on 2 separate occasions, on June 30, 1990 (t0), before starting the integrated activities, and on June 30, 1992 (t1), on completion of a 2-year follow-up. Each patient's history was required to fit a specific category of the International Classification of the Epilepsies (ICE) (1). Response to treatment was classified as complete remission, occasional seizures, recurrent nonrefractory seizures, and drug-resistant epilepsy. A total of 3,469 patients of the ages of 4-80 years were enrolled.

RESULTS

At t0, 44% of cases had localization-related epilepsy, 31% generalized epilepsy, 9% undetermined epilepsy, 6% special syndromes, and 10% epileptic syndromes with atypical features. At t1, the percentages in each category were 51, 27, 7, 6, and 9%. The cases classified as "other" within each syndromic category at t0 were 11-23% and remained unchanged at t1. Patients with symptomatic localization-related epilepsies were largely recoded as symptomatic or cryptogenic epilepsies. About one-third of patients with symptomatic generalized epilepsy were recoded as localization-related epilepsies. Nine percent of patients were classified as "uncertain" epilepsies at t0, and the same proportion at t1. However, many "uncertain" diagnoses became "definite" and vice versa.

CONCLUSIONS

There was a slight increase in the proportion of patients achieving complete remission (from 13 to 28%) and untreated patients (from 10 to 17%). Nine percent of patients unresponsive to treatment at t0 had achieved remission at t1. Drug resistance was confirmed in 78% of cases and was mostly independent of the therapeutic decision. Ten percent of cases achieved remission with unchanged or simplified treatment schedules.