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.
|Titolo:||The contribution of tertiary centers to the quality of the diagnosis and treatment of epilepsy|
|Parole Chiave:||Audit; Classification; Diagnosis; Epilepsy; Treatment|
|Settore Scientifico Disciplinare:||Settore MED/26 - Neurologia|
Settore MED/39 - Neuropsichiatria Infantile
|Data di pubblicazione:||1997|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1111/j.1528-1157.1997.tb00072.x|
|Appare nelle tipologie:||01 - Articolo su periodico|