Background: To evaluate the incidence and the prevalence of drug resistant ep ilepsies and risk factors in relation with this condition. Methods: The epidemio logical approach of drugresistant epilepsies come up again...Background: To evaluate the incidence and the prevalence of drug resistant ep ilepsies and risk factors in relation with this condition. Methods: The epidemio logical approach of drugresistant epilepsies come up against two major difficult ies: the lack of a rigorous and consensus definition of this condition and its e lusive evaluation which is indirectly appreciated with many studies concerning t he remission of seizures in heterogeneous population of patients with or without treatment. Results: The majority of papers on this topic report a hard core of 20 p.100 of patients who continue to have seizures under treatment. This percent age has to be discussed because many factors can influence the exact number of p atients with refractory epilepsy: the age of the first seizure, the seizure type , the cause of the seizures, the effective therapeutic interventions. This peren tage did not seem to have been modified since the use of “new”anti epileptic drugs and the development of epilepsy surgery. The main problem is to appreciate when refractoriness is really present and how long does it takes to declare tha t this condition has a self perpetuating progression. Thank to the data from an abundant literature we can put forward that nearly 10 p. 100 of the incident ca ses could become refractory and that 1 to 2/1 000 persons are drug resistant epi lepsies, of which partial epilepsies represent 60 p. 100 of the cases. This rate allows to think that in France 5 000 to 12 000 patients may require a surgical evaluation and that annual need for surgery would be 500 patients per year. Conc lusions: Data on drug resistant epilepsies in France are lacking and it seems e ssential to put in place in our country a population based incidence study incl uding the risk factors of intractability in order to confirm these epidemiologic al data. The results of such a study would help to convince the political author ities to encourage the development of surgical structures.展开更多
文摘Background: To evaluate the incidence and the prevalence of drug resistant ep ilepsies and risk factors in relation with this condition. Methods: The epidemio logical approach of drugresistant epilepsies come up against two major difficult ies: the lack of a rigorous and consensus definition of this condition and its e lusive evaluation which is indirectly appreciated with many studies concerning t he remission of seizures in heterogeneous population of patients with or without treatment. Results: The majority of papers on this topic report a hard core of 20 p.100 of patients who continue to have seizures under treatment. This percent age has to be discussed because many factors can influence the exact number of p atients with refractory epilepsy: the age of the first seizure, the seizure type , the cause of the seizures, the effective therapeutic interventions. This peren tage did not seem to have been modified since the use of “new”anti epileptic drugs and the development of epilepsy surgery. The main problem is to appreciate when refractoriness is really present and how long does it takes to declare tha t this condition has a self perpetuating progression. Thank to the data from an abundant literature we can put forward that nearly 10 p. 100 of the incident ca ses could become refractory and that 1 to 2/1 000 persons are drug resistant epi lepsies, of which partial epilepsies represent 60 p. 100 of the cases. This rate allows to think that in France 5 000 to 12 000 patients may require a surgical evaluation and that annual need for surgery would be 500 patients per year. Conc lusions: Data on drug resistant epilepsies in France are lacking and it seems e ssential to put in place in our country a population based incidence study incl uding the risk factors of intractability in order to confirm these epidemiologic al data. The results of such a study would help to convince the political author ities to encourage the development of surgical structures.
