Unit:
Τομέας Κοινωνικής Ιατρικής - Ψυχιατρικής και ΝευρολογίαςLibrary of the School of Health Sciences
Dissertation committee:
Μ. Κουτρουμανίδης, Professor of Neurology, Department of Clinical Neurophysiology and Epilepsies Guy's and St. Thomas NHS Foundation Trust
Σ. Γκατζώνης, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Γ. Παρασκευάς, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Κ. Πόταγας, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Σ. Κορφιάς, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Σ. Βασιλοπούλου, Επίκουρη Καθηγήτρια, Ιατρική, ΕΚΠΑ
Α. Κυρώζης, Επίκουρος Καθηγητής, Ιατρική, ΕΚΠΑ
Original Title:
Κλινική μελέτη των κλινικών, απεικονιστικών και νευροφυσιολογικών χαρακτηριστικών της έσω κροταφικής επιληψίας στους ενήλικες.
Translated title:
Drug-responsive versus drug-refractory mesial temporal lobe epilepsy: a single center prospective outcome study.
Summary:
Objectives: Temporal lobe epilepsy (TLE) is the most common form of adult localization-related epilepsy and mesial temporal lobe epilepsy (MTLE) is its most frequent epileptic type in adults. The purpose of this study was to evaluate clinical, electrophysiological, and neuroradiological factors which correlate with prognosis in patients with mesial temporal lobe epilepsy (MTLE), aiming to assess the evolution of the disease over time and investigate possible predictors of resistance to AED treatment that can complement official criteria and guidelines.
Methods: This was a single centre prospective outcome study in patients with MTLE. We evaluated patients diagnosed and medically treated at the Department of Clinical Neurophysiology and Epilepsies, of Guy’s and St. Thomas’ NHS Foundation Trust, London, UK, and actively followed up at the outpatient epilepsy clinic from September 2013 to December 2014. Their family history, clinical characteristics, neurophysiological data (electroencephalography -EEG), neuroimaging, antiepileptic therapy and outcome, were
collected and analyzed. All patients were clinically evaluated at least twice for the duration of the study. The population was divided into four groups depending on the frequency of the seizures at last follow up. All variables and outcome measures were compared between the four groups.
Results: Eighty three consecutive patients were included. Group 1 (seizure free) included 7 patients, (9 %), Group 2 (rare seizures) included 15 patients (18%), Group 3 (often seizures) comprised 30 patients (36%) and Group 4 (very often seizures) consisted of 31 patients (37%). Groups did not differ significantly in demographic characteristics. There was a strong positive correlation between resistance to therapy and sleep activation on EEG (p=0.005, x2= 7.6), occurrence of focal to bilateral seizures (p=0.007, x2=26.9), ictal automatisms (p=0.004, x2=8.3) and number of previously used antiepileptic drugs (AEDs) (p=0.002, x2=9.2). No association between febrile convulsions (FC), hippocampal sclerosis (HS) and outcome was found.
Conclusion: MTLE is a heterogeneous syndrome. Establishing the factors responsible for and associated with drug resistance is important for optimal management and treatment, as early identification of drug resistance should lead to timely referral for surgical treatment. This prospective study shows that sleep activation on EEG, ictal automatisms, occurrence of focal to bilateral tonic clonic seizures and increased number of tried AEDs are negative prognostic factors.
Main subject category:
Health Sciences
Keywords:
Mesial temporal lobe epilepsy, Prognostic factors, Outcome, Resistance, Responsiveness
Number of references:
217
