Risk factors for drug-resistant epilepsy: A systematic review and meta-analysis

Abstract

Background: Drug resistant epilepsy (DRE) is very common among children and adults and studies had found some related risk factors for DRE, while the results were not consistent. The aim of this study was to identify risk factors for drug-resistant epilepsy. Methods: Three electronic databases (Medline, Embase and Cochrane library) were searched to identify studies with a cohort design reporting on epidemiologic evidence regarding risk factors for DRE. Results: The pooled prevalence of DRE in newly diagnosed epilepsy patients was 25% (95% CI 17-32%). Abnormal electroencephalography (EEG) (both slow wave and epileptiform discharges) (RR 2.80; 95% CI 1.95-4.0), status epilepticus (SE) (RR 11.60; 95% CI 7.39-18.22), symptomatic etiology (RR 3.36; 95% CI 2.53-4.46), multiple seizure types (RR 3.66; 95% CI 2.37-5.64) and febrile seizures (RR 3.43; 95% CI 1.95-6.02) were identified as strong risk factors for DRE. In addition, firm conclusions cannot be drawn for poor short-term outcomes of therapy, neurodevelopment delay and high initial seizure frequency for the heterogeneity of study results. The predictive effect of focus onset seizure was not stable after removing one study and switching the effect model. Age of onset was not risk factors for DRE. Conclusions: The current meta-analysis identified potential risk factors for DRE. The results may contribute to better prevention strategies and treatments for DRE. Abbreviations: DRE = drug-resistant epilepsy, EEG = electroencephalogram, MTLE = mesial temporal lobe epilepsy, CI = confidence interval, RR = relative risk, AED = anti-epileptic drug, CNS = central nervous system, ILAE = International League against Epilepsy, MTLEHS = mesial temporal lobe epilepsy with hippocampal sclerosis.