Epilepsy Etiology in a Latin American Cohort using the 2017 ILAE Classification
Irving Fuentes1, Jimena Gonzalez Salido1, Jimena Colado1, Fernando Vasquez Lopez1, Betsy Vazquez1, Luis Marin-Castañeda1, Mijail Rivas1, Eithel Valenzuela Mendivil1, Salvador Martinez-Medina1, Mario A. Sebastian-Díaz2, Iris E. Martínez-Juárez1
1Epilepsy Clinic & Clinical Epileptology Fellowship, National Institute of Neurology and Neurosurgery “Manuel Velasco Suarez” (NINNMVS) & Faculty of Medicine, UNAM, Mexico City and Clinical Epileptology Fellowship NINNMVS/UNAM, 2Nephrology Department, South Central High Specialty Hospital PEMEX, Mexico City, Mexico.
Objective:
To determine the etiologies of epilepsy in a cohort of patients in Latin America using the 2017 ILAE classification.
Background:
Epilepsy is linked to multiple causes, including traumatic brain injuries, infections, neoplasms, and genetic factors (1,2). Identifying the underlying etiology could influence diagnosis, prognosis, and management. (3,4).
Design/Methods:
An observational, descriptive, cross-sectional study was conducted on patients diagnosed with epilepsy at NINN from 2021 to 2024. SPSS® 29 was used for data analysis. For quantitative variables mean and standard deviation Chi-square or Fisher's exact test were used; while frequencies and percentages and T-test or Mann Whitney U were used for numerical variables.
Results:
500 patients were included, 213 (42.6%) male, mean age 36.21±13.43 years (range 15 - 79). Mean epilepsy duration 13.94 ± 6.815 years (range 1-21). 331 (66.2%) had focal seizures, 138 (27.6%) had focal to bilateral tonic-clonic seizures, 18 (3.6%) had combined focal and generalized seizures, and 10 (2%) had seizures of unknown origin.
Regarding etiology: 294 (58.8%) were structural, 125 (25%) unknown, 78 (15.6%) genetic, 19 (3.8%) immune-related, 8 (1.6%) infectious and 3 (0.6%) metabolic. 27 (5.4%) patients had more than one etiology.
Patients with a family history of epilepsy showed a higher likelihood of a genetic etiology (p< 0.001). Mean age of patients with a structural etiology (38.98 ± 13.803 years) was significantly higher than patients with genetic etiology ( 30 ± 10.585 years) (p < 0.001). 84.4% ( 248 ) with focal epilepsy had a structural etiology (p<0.001), while 67.9% ( 54 ) with generalized epilepsy had a genetic etiology (p<0.001).
Conclusions:
Epilepsy is a multifactorial disease, with diagnoses involving overlapping etiologies, as recognized in the 2017 ILAE classification. Structural etiology was the most frequent, with older age and focal seizure whereas genetics had more family history, younger age, and generalized seizures.
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