Drug-resistant epilepsy after a first unprovoked seizure in adolescence and adulthood: A prospective cohort study

We present a monocentric prospective study performed on a population of 394 consecutive patients with a first unprovoked seizure evaluated from January 1st 2006 to December 31st 2009 with the purpose to identify the short-term frequency of drug-resistant epilepsy (DRE) in patients with a first seizure in adolescence or adulthood. Drug resistance was determined using two different definitions: (a) Berg, 20061; (b) ILAE, 20102. We identify 18 ILAE DRE patients (6,5%) and 10 (4,5%) Berg DRE patients. Fifteen patients have focal epilepsy (12 symptomatic, 3 cryptogenic); 2 patients have idiopathic generalized epilepsy, one had cryptogenic generalized epilepsy. Three DRE patients had at onset status epilepticus, and all DRE patients had the second seizure within three months from the onset. Conclusion: These results suggest that: (a) epilepsy onset in adolescence/adulthood is associated wit a low percentage (4-7%) of DRE; (b) these patients quickly became drug-resistant, supporting the concept of DRE as expression of intrinsic severity of the disease (Sillanpaa et al, 2009). Early detection of these patients can lead to early epilepsy surgery.