[Adult patients treated for focal epilepsy with antiepileptic drugs (AEDs) in combination in France: description according to the 2009 ILAE definition of AED resistance (ESPERA study)].
OBJECTIVE
To describe the adult population treated with antiepileptic drugs (AEDs) in combination for focal epilepsy according to the definition of AED resistance proposed by the International League Against Epilepsy (ILAE) in 2009 and to evaluate its implementation in current practice.


METHODS
ESPERA was a multicenter, observational, cross-sectional study with a clinical data collection covering the past 12 months conducted by neurologists. Classifications according to AED responsiveness established by investigators for each enrolled patient were revised by two experts.


RESULTS
Seventy-one neurologists enrolled 405 patients. Their mean age was 42.7 years (sex-ratioM/F 0.98). According to the investigators, 60% of epilepsies were drug-resistant, 37% drug-responsive and 3% had an undefined drug-responsiveness. After revision of experts, 71% of epilepsies were classified as drug resistant, 22% as responsive and 7% as undefined. Among the participating neurologists, 76% have made at least one error in classifying their patients according to the 2009 ILAE definition of AED resistance. Because of epilepsy, 24% of patients (age≤65) were inactive and 42% could not drive (respectively 29 and 49% of patients with AED resistant epilepsy). Half of patients had at least one other chronic condition. Number of prescribed drugs in combination and health care resource utilisation were significantly higher in patients with drug-resistant epilepsies than in patients with drug responsive epilepsies.


CONCLUSIONS
ESPERA study shows that the use of new definition of drug-resistance in everyday practice seems difficult without any additional training and that the social and professional disability is frequent in adults with focal epilepsies treated with polytherapy.
Service de neurologie, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
H
H
Vespignani
Cemka-Eval, 43, boulevard du Maréchal-Joffre, 92340 Bourg-la-Reine, France. Electronic address: marie.dezelicourt@cemka.fr.
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M
de Zélicourt
Cemka-Eval, 43, boulevard du Maréchal-Joffre, 92340 Bourg-la-Reine, France.
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C
Laurendeau
Cemka-Eval, 43, boulevard du Maréchal-Joffre, 92340 Bourg-la-Reine, France.
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F
Fagnani
GSK, 100, route de Versailles, 78160 Marly-le-Roi, France.
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L
Levy-Bachelot
GSK, 100, route de Versailles, 78160 Marly-le-Roi, France.
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C
Murat
Unité d'épilepsie et malaises d'origine neurologique (EMN), laboratoire de neurophysiopathologie de l'épilepsie (LNPEE), CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
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P
Kahane
Inserm U390, CHU de Tours, université François-Rabelais, 10, boulevard Tonnelé, 37032 Tours cedex 1, France.
B
B
de Toffol
D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D004351:Drug Resistance / Q000187:drug effects; D004828:Epilepsies, Partial / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D000927:Anticonvulsants; D004338:Drug Combinations
Adultes; Adults; Definitions; Drug-resistance; Définitions; Focal epilepsy; Pharmacorésistance; Polytherapy; Polythérapie; Épilepsie focale