Rationale and objective: Epileptic seizure disorders have
become an increased source of concern in veterans given their
relative high exposure to traumatic brain injury (TBI). 40% of adults
with focal epilepsy are expected to develop treatment-resistant
epilepsy (TRE), which can be amenable to treatment with epilepsy
surgery. Yet, epilepsy surgery in veterans with epilepsy (VWE) is
performed less frequently than in non-veterans with epilepsy. One
possible explanation may be that when seizures begin after the
age of 50, seizure freedom is likely to occur in 70% of patients. The
purpose of this study was to examine whether the frequency of
treatment-resistant epilepsy was different in veterans and to identify
potential variables that may account for this difference.
Methods: In this retrospective study we included 157
veterans followed in the outpatient clinic of the Miami Epilepsy Center
of Excellence Veterans Health Administration. Data collected from the
medical records included age at onset of epilepsy, etiology,
seizure type and epilepsy syndrome, response to pharmacotherapy,
presence of psychiatric co morbidities (classified as mood
disorders, generalized anxiety disorder, post-traumatic stress disorder,
polysubstance abuse and other), antiepileptic regimen and
adherence to medical treatment.
Results: Among the 157 patients, the mean age was 56.7 (±15.4) years and 140 (88.5%) were males; 119 patients (75.7%)
had focal epilepsy presenting with complex partial with or without secondarily generalized tonic-clonic (GTC) seizures. TRE was
identified in 25 patients (15.9%; 95% confidence interval: 11.0% to 22.5%); being a woman (p<0.01) and having focal epilepsy
(p=0.04) were the only two significant variables associated with the development TRE.
Conclusion: In this study, the prevalence of TRE in this cohort of veterans was lower than that reported in the general epilepsy
population. These findings need to be replicated in a larger study that includes the 16 VA Epilepsy Centers of Excellence.
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