title: How long does it take for epilepsy to become intractable? A prospective investigation.
abstract: OBJECTIVE
  To determine prospectively when in the course of epilepsy intractability becomes apparent.
  
  
  METHODS
  Data are from a prospective cohort of 613 children followed for a median of 9.7 years. Epilepsy syndromes were grouped: focal, idiopathic, catastrophic, and other. Intractability was defined in two ways: (1) 2 drugs failed, 1 seizure/month, on average, for 18 months (stringent), and (2) failure of 2 drugs. Delayed intractability was defined as 3 or more years after epilepsy diagnosis.
  
  
  RESULTS
  Eighty-three children (13.8%) met the stringent and 142 (23.2%) met the two-drug definition. Intractability depended on syndrome (p < 0.0001): 26 (31.3%) children meeting stringent and 39 (27.5%) meeting the 2-drug definition had delayed intractability. Intractability was delayed more often in focal than catastrophic epilepsy (stringent: 46.2 vs 14.3%, p = 0.003; two-drug: 40.3 vs 2.2%, p <or= 0.0001). Early remission periods preceded delayed intractability in 65.4 to 74.3% of cases. After becoming intractable, 20.5% subsequently entered remission and 13.3% were seizure free at last contact.
  
  
  CONCLUSIONS
  Intractable epilepsy may be delayed, especially in focal epilepsy. It often is preceded by a quiescent period, followed by further remissions. These findings help explain why surgically treatable epilepsies may take 20 years or longer before referral to surgery.
authors: Department of Biology, Northern Illinois University, DeKalb, 60115, USA. atberg@niu.edu
authors: Anne T
authors: AT
authors: Berg
authors: Barbara G
authors: BG
authors: Vickrey
authors: Francine M
authors: FM
authors: Testa
authors: Susan R
authors: SR
authors: Levy
authors: Shlomo
authors: S
authors: Shinnar
authors: Frances
authors: F
authors: DiMario
authors: Susan
authors: S
authors: Smith