Drug-resistant epilepsy in Morocco: description, prevalence and predictive factors in Casablanca-Settat region

Drug-resistant epilepsy (DRE) affects about one-third of people with epilepsy (PWE). Our study aims to estimate the DRE prevalence and its predictive factors in Morocco. A cross-sectional study was conducted over 18 months. PWE with clinical diagnosis of epilepsy, and with an antiseizure treatment duration >12 months were examined in the neurology, neurosurgery, psychiatry, and pediatrics departments, of different sampled clinical sectors for the Casablanca-Settat region. Sociodemographic and clinical data were collected using a questionnaire during consultations. Antiseizure multi-therapy, a seizure freedom duration <12 months, compliance, and adequate posology were the determining factors for classifying DRE. Data were analyzed using Statistical Package for Social Sciences (SPSS) software, version 21.0. Statistical significance was set at p < 0.05 and logistic regression was performed to determine the predictive factors. In our sample of 446 PWE, the median age is 25 years (IQR: 11.75 -44.00). The DRE estimated prevalence was 29.4 %. Pseudo-resistant epilepsy (PRE) was 18.0 %. Multivariate logistic regression analysis reports that single marital status (ORa = 1.94; CI95%: 1.02 -3.71), comorbidities and concomitant affections (ORa = 2.14; CI95%: 1.27 -3.59), structural etiology (ORa = 1.96; CI95%: 1.16 -3.30), pre-ictal aura (ORa = 1.90; CI95%: 1.09 -3.29), inter-ictal EEG abnormalities (ORa = 2.45; CI95%: 1.24 -4.84) and allopathic treatment use (ORa = 2.10; CI95%: 1.30 -3.39) are the predictive factors for DRE. We report an alarming DRE prevalence. Associated factors found may contribute to the prognosis and early management. PWE awareness, facilitating healthcare access and the development of epilepsy surgery are the key points to limit DRE in Morocco and prevent its various complications, especially for the pediatric population.