THE CONTRIBUTION OF TERTIARY CENTERS TO THE QUALITY OF THE DIAGNOSIS AND TREATMENT OF EPILEPSY

Purpose: A survey was made of a network of 14 epilepsy centers in Ital y to assess whether integrated diagnosis and treatment monitoring led to a more precise syndromic classification of the patients and a bette r response to treatment.Methods: Data on the diagnosis and treatment o f epilepsy and the degree of seizure control were recorded in a regist er 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 specifi c category of the International Classification of the Epilepsies (ICE) (1). Response to treatment was classified as complete remission, occa sional seizures, recurrent nonrefractory seizures, and drug-resistant epilepsy. A total of 3,469 patients of the ages of 4-80 years were enr olled. Results: At t0, 44% of cases had localization-related epilepsy, 31% generalized epilepsy, 9% undetermined epilepsy, 6% special syndro mes, and 10% epileptic syndromes with atypical features. At t1, the pe rcentages in each category were 51, 27, 7, 6, and 9%. The cases classi fied as ''other'' within each syndromic category at t0 were 11-23% and remained unchanged at t1. Patients with symptomatic localization-rela ted epilepsies were largely recoded as symptomatic of cryptogenic epil epsies. About one-third of patients with symptomatic generalized epile psy were recoded as localization-related epilepsies. Nine percent of p atients were classified as ''uncertain'' epilepsies at t0, and the sam e proportion at t1. However, many ''uncertain'' diagnoses became ''def inite'' and vice versa. Conclusions: There was a slight increase in th e proportion of patients achieving complete remission (from 13 to 28%) and untreated patients (from 10 to 17%). Nine percent of patients unr esponsive to treatment at t0 had achieved remission at t1. Drug resist ance was confirmed in 78% of cases and was mostly independent of the t herapeutic decision. Ten percent of cases achieved remission with unch anged or simplified treatment schedules.