title: Family history and frontal lobe seizures predict long-term remission in newly diagnosed cryptogenic focal epilepsy.
abstract: OBJECTIVE
  Cryptogenic focal epilepsy (CFE) is a heterogeneous clinical disorder including patients with severe refractory forms and patients with a fairly good prognosis. Predictors of prognosis in CFE are poorly understood. The aim of this retrospective study is to identify long-term (5-year) prognostic predictors in patients with newly diagnosed CFE.
  
  
  METHODS
  Subjects with cryptogenic focal epilepsy (CFE) seen from April 1987 to September 2011 in two twin Epilepsy Centres located in Reggio Calabria and Catanzaro, Calabria, Southern Italy, were screened. Patients were excluded if they had psychogenic seizures, major psychiatric disorders presence of brain lesions except for non-specific white matter T2-hyperintensities, short follow-up (less than five years) or for having received the diagnosis of CFE elsewhere. One hundred and eighty-six patients, firstly diagnosed in our Centres, constituted the study sample. Survival curves were generated according to the Kaplan-Meier method and compared with the log-rank test. The endpoint was the cumulative time-dependent chance of 5-year remission after treatment start. Independent predictors of remission were tested by multivariate analysis using Cox proportional hazards function models. The accuracy of the resulting model was tested with Receiver Operating Characteristics (ROC) curve analysis.
  
  
  RESULTS
  The cumulative incidence of remission was 23%. At Kaplan-Meier analysis, the only factor predicting remission was family history of epilepsy or febrile seizures (FS; p=0.02). At Cox regression, family history and frontal lobe epilepsy showed to be independent predictors of outcome (p=0.02 and 0.03, respectively). The accuracy of these predictors was good (area under ROC curve 0.648, 95% CI 0.575-0.716). Interestingly, we also found a considerable (7 years) diagnostic delay that did not result in a worse prognosis.
  
  
  CONCLUSIONS
  About one quarter of subjects with newly diagnosed CFE attains 5-year seizure remission during follow-up. Family history of epilepsy or FS and frontal localization are independent prognostic predictors.
authors: Magna Græcia University of Catanzaro, Regional Epilepsy Center at Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria, Italy.
authors: Sara
authors: S
authors: Gasparini
authors: Edoardo
authors: E
authors: Ferlazzo
authors: Ettore
authors: E
authors: Beghi
authors: Giovanni
authors: G
authors: Tripepi
authors: Angelo
authors: A
authors: Labate
authors: Laura
authors: L
authors: Mumoli
authors: Cinzia G
authors: CG
authors: Leonardi
authors: Vittoria
authors: V
authors: Cianci
authors: Maria Adele
authors: MA
authors: Latella
authors: Antonio
authors: A
authors: Gambardella
authors: Umberto
authors: U
authors: Aguglia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000503:physiopathology; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cryptogenic epilepsy; Family history; Focal epilepsy; Frontal lobe seizures; Prognosis; Remission