Seizure relapse in new onset epilepsy : It is not always drug resistance

Article Article scientifique Article Seizure relapse in new onset epilepsy : It is not always drug resistance eng 2026-06-11 author Catania Cécilia 0009-0008-4893-1062 Department of Clinical Neurosciences, EEG & Epilepsy Unit, University Hospitals of Geneva, Geneva, Switzerland. 419141 author Menetre Eric 0000-0002-1101-1288 Department of Clinical Neurosciences, EEG & Epilepsy Unit, University Hospitals of Geneva, Geneva, Switzerland. 723633 author Fitsiori Aikaterini 0000-0002-4540-1428 Diagnostic and Interventional Neuroradiology Unit, Berne, Switzerland. 919174 Département de radiologie et informatique médicale (RADIO) author Kurz Félix Tobias 0000-0001-7616-7147 Diagnostic and Interventional Neuroradiology Unit, Berne, Switzerland. 419472 author Moreno Legast Gabriela 0000-0002-1940-2232 Department of Clinical Neurosciences, EEG & Epilepsy Unit, University Hospitals of Geneva, Geneva, Switzerland. 416809 author Vulliemoz Serge 0000-0002-1877-8625 Department of Clinical Neurosciences, EEG & Epilepsy Unit, University Hospitals of Geneva, Geneva, Switzerland.,CIBM Center for Biomedical Imaging, Lausanne, Switzerland. 712268 Département des neurosciences cliniques (OTONO) author Genoud Mathieu Emergency Department, University Hospitals of Geneva, Geneva, Switzerland. 544053 author Megevand Pierre Bastien 0000-0002-0427-547X Department of Clinical Neurosciences, EEG & Epilepsy Unit, University Hospitals of Geneva, Geneva, Switzerland. 510484 Département des neurosciences cliniques (OTONO) author Wiest Roland Diagnostic and Interventional Neuroradiology, University Hospital, Berne, Switzerland. author Picard Fabienne Department of Clinical Neurosciences, EEG & Epilepsy Unit, University Hospitals of Geneva, Geneva, Switzerland. 123049 Département des neurosciences cliniques (OTONO) author Beniczky Sandor 0000-0002-6035-6581 Department of Clinical Neurophysiology, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark. author Seeck Margitta Department of Clinical Neurosciences, EEG & Epilepsy Unit, University Hospitals of Geneva, Geneva, Switzerland. 133679 Département des neurosciences cliniques (OTONO) 10.1002/epi.70298 42274285 0013-9580 https://onlinelibrary.wiley.com/doi/10.1002/epi.70298 Objective: Seizure recurrence in new onset epilepsy (NOE) can result from various factors. Although drug ineffectiveness is frequently investigated, other causes-such as nonadherence, inadequate treatment, nonepileptic events (e.g., functional/dissociative), or acute symptomatic seizures-also impact patient outcomes. This retrospective, longitudinal single-center study evaluated relapse causes over a 5-year period in a cohort of NOE patients. Methods: We reviewed the NOE registry of Geneva University Hospital, including adult patients diagnosed between 2005 and 2019. Of 740 consecutive patients, 330 with more than 5 years of follow-up were included in the analysis. Relapses after antiseizure medication (ASM) initiation were classified into seven categories: poor adherence, inadequate treatment, ineffective treatment, acute symptomatic seizures, nonepileptic seizures, multiple, and unknown causes. Mixed-effects logistic regression and post hoc analyses were used to assess temporal trends. Results: A total of 202 of 330 patients (61%) experienced at least one relapse; 181 occurred after ASM initiation. Of these, 32% (57/181) were due to treatment ineffectiveness, whereas 68% were attributable to other causes. Inadequate treatment was the most frequent cause in year 1 (37%) but declined to 10% by year 5 (p < .001). Poor adherence remained stable (27%-38%). The proportion of drug ineffectiveness as a cause of relapse increased over time (22% in year 1 to 41% in year 5). Drug-resistant epilepsy (DRE) was diagnosed in 7% of the entire cohort. Generalized tonic-clonic (GTC) seizures at relapse were associated with poor adherence, whereas non-GTC seizures were linked to ineffectiveness (p < .001). Significance: In our cohort, most early relapses in NOE were due to modifiable factors. Systematic identification of relapse causes can prevent misclassification of DRE and reduce unnecessary treatment escalation. The high proportion of patients lost to follow-up is a relevant limitation of this study; however, a substantial selection bias is unlikely. EEG Acute symptomatic seizure Adherence Adults Antiepileptic treatment Antiseizure medication Compliance Epilepsy surgery First seizure Functional/dissociative seizures Nonepileptic seizures Pharmacoresistance Dewey 616.8 Dewey 617 Swiss National Science Foundation Transcranial electrical current stimulation as a treatment in epilepsy 163398 CH 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 61 Département des neurosciences cliniques 226 false 733 NeuroPsychoLinguistique 1470 Laboratoire de neuroimagerie quantitative et computationnelle 1078 1279 Epilepsie et réseaux cérébraux 1002 1361 Human Neuron Lab 1034 119 Epilepsie et Chirurgie 149 Epilepsia e56e9ec1-bbf3-4a10-8d6f-1cb0f730a0fa Article (Published version) Public Catania_et_al._-_2026_-_Seizure_rel.pdf 937857 application/pdf CC BY-4.0 417a5986e84d2b7dbe1126cd65d6fc263def6551afe548d548a2da8b70b43c8a 3b14191e-0af3-441f-af16-6da3449a3591 Supplemental data Public epi70298-sup-0001-tabless1-s4-1.docx 25799 application/vnd.openxmlformats-officedocument.wordprocessingml.document c716ed47e35898e2939b394c3eb9b0d30458846f4975389bbc05e9effa83c218 openAccess Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences Faculté de médecine / Section de médecine clinique / Département des neurosciences cliniques

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Seizure relapse in new onset epilepsy : It is not always drug resistance	Epilepsia			2026	7	7

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