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Objective: To delineate the temporal patterns of outcome and to determine the probability of seizure freedom with successive antiepileptic drug regimens in newly diagnosed epilepsy.Methods: Patients in whom epilepsy was diagnosed and the first antiepileptic drug prescribed between July 1, 1982, and April 1, 2006, were followed up until March 31, 2008. Outcomes were categorized into 4 patterns: A) early and sustained seizure freedom; B) delayed but sustained seizure freedom; C) fluctuation between periods of seizure freedom and relapse; and D) seizure freedom never attained. Probability of seizure freedom with successive drug regimens was compared. Seizure freedom was defined as no seizures for Ն1 year.Results: A total of 1,098 patients were included (median age 32 years, range 9-93). At the last clinic visit, 749 (68%) patients were seizure-free, 678 (62%) on monotherapy. Outcome pattern A was observed in 408 (37%), pattern B in 246 (22%), pattern C in 172 (16%), and pattern D in 272 (25%) patients. There was a higher probability of seizure freedom in patients receiving 1 compared to 2 drug regimens, and 2 compared to 3 regimens (p Ͻ 0.001). The difference was greater among patients with symptomatic or cryptogenic than with idiopathic epilepsy. Less than 2% of patients became seizure-free on subsequent regimens but a few did so on their sixth or seventh regimen. Conclusions:Most patients with newly diagnosed epilepsy had a constant course which could usually be predicted early. The chance of seizure freedom declined with successive drug regimens, most markedly from the first to the third and among patients with localization-related epilepsies. Neurology Seventy million people have epilepsy, with 34 -76 per 100,000 developing the condition every year.1 To formulate rational treatment plans, it is important to understand the different clinical courses and patterns of response to antiepileptic drugs (AEDs), ideally by following outcomes from the point of treatment initiation. Most studies conducted at specialist centers were limited by selection bias toward patients with chronic refractory epilepsy.2-5 The few reported cohorts of newly diagnosed patients tended to include only children 6,7 or focus on response over time irrespective of treatment status. 8 We have previously reported outcomes in adolescent and adult patients with newly diagnosed epilepsy.9,10 Over the ensuing years many new AEDs have become available, but their impact on the overall prognosis of epilepsy remains unclear. The main objectives of the present analysis were to delineate the temporal patterns of seizure outcome and to determine the probability of seizure freedom with successive regimens in an expanded cohort of 1,098 newly diagnosed patients, who were recruited between 1982 and 2006 and followed for up to 26 years. Most were referred by their primary care physicians with less than 10% by the hospital's accident and emergency department. The study population included the patients analyzed in our previous reports (n ϭ 470 and 890, ...

Accumulating evidence implicates inflammation as a potential pathway in the pathogenesis of type 2 diabetes. The objective of the present study was to assess the ability of C-reactive protein (CRP) to predict the development of diabetes in middle-aged men in the West of Scotland Coronary Prevention Study. Baseline plasma samples for CRP measurement were available for 5,245 men of whom 127 were classified as having a transition from normal glucose control to overt diabetes during the study, based on American Diabetes Association criteria. Baseline CRP was an important predictor of the development of diabetes in univariate analysis (hazard ratio [HR] for an increase of 1 SD ‫؍‬ 1.55; 95% CI 1.32-1.82; P < 0.0001). In multivariate analysis, CRP remained a predictor of diabetes development (HR 1.30; 95% CI 1.07-1.58; P ‫؍‬ 0.0075) independent of other clinically employed predictors, including baseline BMI and fasting triglyceride and glucose concentrations. Moreover, there was a graded increase in risk across CRP quintiles throughout the study, evident at even 1 year of follow-up. The highest quintile (CRP >4.18 mg/l) was associated with a greater than threefold risk of developing diabetes (HR 3.07; 95% CI 1.33-7.10) in a multivariate analysis at 5 years. Thus, CRP predicts the development of type 2 diabetes in middle-aged men independently of established risk factors. Because CRP, the most commonly used acute-phase protein in clinical practice, is very stable in serum, our observations have clinical potential in helping to better predict individuals destined to develop type 2 diabetes. They also add to the notion that low-grade inflammation is important in the pathogenesis of type 2 diabetes. Diabetes 51: 1596 -1600, 2002 C -reactive protein (CRP) is the prototypical, and most commonly used, acute-phase reactant marker of inflammation in the body. Increases in CRP concentration (even when within the clinically normal range) and of other inflammatory markers are independently predictive of future cardiovascular events (1,2). Cross-sectional studies have shown that elevated CRP levels correlate significantly with features of the metabolic (insulin resistance) syndrome, including indexes of adiposity, hyperinsulinemia and insulin sensitivity index, hypertriglyceridemia, and low HDL cholesterol (3-5).Recently, data from the Women's Health Study identified elevated levels of CRP as a predictor of the development of diabetes in women (6), independent of BMI and insulin, although other established predictors such as fasting lipids and blood pressure were not considered. This finding is consistent with other studies (7,8) showing that other markers of inflammation (white cell count [WCC], serum albumin, and serum amyloid A) predict the development of diabetes.The objective of the present study was to assess the ability of baseline serum CRP concentration to predict the development of type 2 diabetes in men, in conjunction with other established predictors such as plasma triglyceride, during the 5-year follow-up period of t...

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