PROGNOSIS FOR TOTAL CONTROL OF COMPLEX PARTIAL AND SECONDARILY GENERALIZED TONIC-CLONIC SEIZURES

Background: Two prospective observations of adults with symptomatic, l ocalization-related (partial) epilepsy included 1,102 patients in VA m ulticenter studies (VA-118; and VA-264). Analyses assessed the likelih ood of remaining seizure free for 12 and 24 months after initiating ad equate antiepileptic drug therapy. Methods: Patients were grouped as h aving only secondarily generalized tonic-clonic seizures (GTC), only c omplex partial seizures (CPS), or both types (MIXED) at entry. The cum ulative proportion of patients remaining seizure free with standard an tiepileptic drug therapy was determined by actuarial life table method s. Results: At 12 months, 70% and 61% of GTC patients (VA-118 and VA-2 64, respectively) had no further GTC; 53% and 50% of MIXED, predominan tly GTC patients had no further GTC, 21% and 28% of CPS patients had n o further CPS and 98% and 91% were seizure free for GTC; 32% and 35% o f MIXED, predominantly CPS patients had no further CPS, and 62% and 51 % of patients with MIXED seizure types remained seizure free for CPS f or 12 months after enrollment. Conclusions: The overall prognosis for control of seizures of any type for 12 months was best for those who h ad only GTC at entry (55% and 48%), worst for those who had only CPS a t entry (23% and 26%), and intermediate for those with MIXED seizures at entry (32% and 25%) (all p < 0.0001). Prognosis can be based on the predominant seizure type in patients with multiple types.