Predictors of treatment efficacy in mesial temporal lobe epilepsy and focal epilepsies of other localisations

Mesial temporal lobe epilepsy (MTLE) is characterised by a high rate of drug resistance; however, it remains difficult to predict an individual’s response to treatment at an early stage. There is a need to optimise approaches to identifying predictors of treatment efficacy not only for MTLE but also for focal epilepsies of other localisation (FEOL).

Objective: to identify clinical, anamnestic and neuroimaging predictors of response to drug therapy in patients with MTLE and FEOL, and to identify factors that do not have independent prognostic value.

Material and methods. A retrospective analysis of a database of patients with focal epilepsy was conducted. Binary logistic regression was used to develop a prognostic model.

Results. In the MTLE group (n=297), remission was achieved in 29% of patients, which is significantly lower than in the FEOL group (n=340) – 38.5% (p<0.05). No significant differences were found in the outcomes ‘improvement’ (31.3% vs 28.8%) and ‘no positive effect’ (39.7% vs 32.7%) (p>0.05). According to binary logistic regression (n=540; 36.1% – no positive effect, 63.9% – positive effect), after stepwise exclusion of non-informative predictors, three independent factors remained in the final model. Rare attacks increased the odds of a positive clinical effect (remission or a reduction in attack frequency by more than 50%): the odds ratio (OR) for the categories ‘several times a month’ – 2.51 (p=0.001), ‘several times a year’ – 3.99 (p<0.001), and ‘less than once a year’ – 6.01 (p<0.001). The presence of a brain tumour (OR 0.385; p=0.068) and the presence of epileptic seizures (focal non-motor with impaired consciousness; OR 0.668; p=0.040) reduced the odds. Nagelkerke’s pseudo-R2 was 0.091. The model demonstrated moderate discriminatory power (AUC 0.649; 95% CI 0.600–0.697; p<0.001), high sensitivity (90.7%) and low specificity (24.6%). The eighteen factors analysed, including all electroencephalography and magnetic resonance imaging parameters, gender, age at onset, aura, febrile seizures, and cognitive and affective impairments, did not demonstrate independent prognostic significance.

Conclusion. A low seizure frequency is a protective predictor of a positive response to drug therapy in patients with MTLE and FEOL, whereas the presence of a brain tumour and dialeptic seizures reduces the likelihood of achieving seizure control.

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