The lifelong course of chronic epilepsy: the Chalfont experience

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dc.contributor.authorNovy, Jan
dc.contributor.authorBelluzzo, Marco
dc.contributor.authorCaboclo, Luis Otavio [UNIFESP]
dc.contributor.authorCatarino, Claudia B.
dc.contributor.authorYogarajah, Mahinda
dc.contributor.authorMartinian, Lillian
dc.contributor.authorPeacock, Janet L.
dc.contributor.authorBell, Gail S.
dc.contributor.authorKoepp, Matthias J.
dc.contributor.authorThom, Maria
dc.contributor.authorSander, Josemir W.
dc.contributor.authorSisodiya, Sanjay M.
dc.contributor.institutionUCL Inst Neurol
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionKings Coll London
dc.contributor.institutionSEIN
dc.date.accessioned2016-01-24T14:34:27Z
dc.date.available2016-01-24T14:34:27Z
dc.date.issued2013-10-01
dc.description.abstractThe long-term outcome of chronic epilepsy remains largely unknown, despite a long historical experience. We report the lifelong course of epilepsy of an historical cohort of 235 subjects who were in residential care at the Chalfont Centre for Epilepsy: 122 had comprehensive post-mortem examination. the populations admitted as resident to the centre over time followed the evolution of society's perception of epilepsy. 'Early residents' (before 1972) were admitted for sheltered employment, escaping stigmatization, whereas 'later' residents with more severe epilepsies were admitted for care. Subjects admitted before 1972 were similar to subjects followed nowadays as outpatients, whereas patients admitted later with a higher burden of disabilities are often those in residential care. This long follow-up allowed exploration of a wide spectrum of epilepsies, affecting both subjects who were otherwise healthy and those with co-morbidities. Age at death showed a bimodal distribution with an early peak of mortality between 45-50 years old, whilst the remainder had life expectancy comparable to the general population. As a group, subjects who had post-mortem examination were not significantly different from patients who did not have post-mortem examination, but post-mortem examination provided data that were otherwise unavailable. for those who had post-mortem examination, sudden unexpected death in epilepsy (SUDEP, 18% of all deaths) did not fully explain the early mortality, to which co-morbidities contributed. High seizure frequency was a significant independent predictor of early death even after excluding SUDEP (e.g. reduction in years of life for those who had > 4 seizures/month compared with those who had < 1 seizure/month: 13 years; 95% confidence interval: 6-19; overall P = 0.0006). Those who survived to older age increasingly went into spontaneous remission lasting until death (in the whole cohort, 38/166, 23% of those who died in or after sixth decade). in subjects who had post-mortem examination, older age (odds ratio = 1.13; 95% confidence interval: 1.06-1.20) and presence of neuropathologically confirmed degenerative changes (that were not the cause of epilepsy) (odds ratio 7.14; 1.95-26.2) were independent predictors of terminal remission. Epilepsy may cause premature death indirectly through co-morbid conditions. Terminal remission occurs even without prior remissions; ageing may improve epilepsy drug responsiveness although unknown factors related to the natural history may also play a role.en
dc.description.affiliationUCL Inst Neurol, NIHR Univ Coll London Hosp, Dept Clin & Expt Epilepsy, Biomed Res Ctr, London WC1N 3BG, England
dc.description.affiliationUniversidade Federal de São Paulo, Dept Neurol & Neurosurg, São Paulo, Brazil
dc.description.affiliationUCL Inst Neurol, NIHR Univ Coll London Hosp, Biomed Res Ctr, Div Neuropathol, London WC1N 3BG, England
dc.description.affiliationKings Coll London, Div Hlth & Social Care Res, London SE1 3QD, England
dc.description.affiliationSEIN, NL-2103 SW Heemstede, Netherlands
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Dept Neurol & Neurosurg, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipMedical Research Council
dc.description.sponsorshipEpilepsy Society
dc.description.sponsorshipNational Institute for Health Research University College London Hospitals Biomedical Research Centre
dc.description.sponsorshipSwiss National Science Foundation
dc.description.sponsorshipSICPA Foundation, Prilly, Switzerland
dc.description.sponsorshipNIHR Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London
dc.description.sponsorshipMarvin Weil Epilepsy Research Fund
dc.description.sponsorshipIDMedical Research Council: G0600934
dc.format.extent3187-3199
dc.identifierhttp://dx.doi.org/10.1093/brain/awt117
dc.identifier.citationBrain. Oxford: Oxford Univ Press, v. 136, p. 3187-3199, 2013.
dc.identifier.doi10.1093/brain/awt117
dc.identifier.issn0006-8950
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/36776
dc.identifier.wosWOS:000325166500032
dc.language.isoeng
dc.publisherOxford Univ Press
dc.relation.ispartofBrain
dc.rightsinfo:eu-repo/semantics/openAccess
dc.rights.licensehttp://www.oxfordjournals.org/access_purchase/self-archiving_policyb.html
dc.subjectmortalityen
dc.subjectSUDEPen
dc.subjectco-morbiditiesen
dc.subjectremissionen
dc.subjectageen
dc.subjectdrug-resistant epilepsyen
dc.titleThe lifelong course of chronic epilepsy: the Chalfont experienceen
dc.typeinfo:eu-repo/semantics/article
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