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Treatment strategy for the patient with hippocampal sclerosis who failed to the first antiepileptic drug.

Lee SK - J Epilepsy Res (2014)

Bottom Line: Thus intractable state is not a static condition but a fluctuating one and initial refractoriness does not necessarily mean the final intractability.Even though the chance of seizure remission with AEDs is not high for MTLE, some of them do well respond to drugs.It is even possible to withdraw AEDs for a few patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT
Despite many epilepsy patients respond to antiepileptic drugs (AED) successfully, more than 30% of patients continue to have seizures on multiple AEDs. The refractory epilepsy increases the risk of cognitive deterioration, psychosocial dysfunction, and sudden unexpected death of epilepsy patients (SUDEP). It is important to identify refractory epilepsy early and make the goal of epilepsy treatment as the prevention of decline in social, vocational, and cognitive performances and minimizing the risk of accident or SUDEP. The syndrome of medial temporal lobe epilepsy with hippocampal sclerosis (MTLE with HS) is often resistant to AEDs, and surgically remediable. Initially well-controlled seizures often become intractable to AEDs. There are progressive behavioral changes including increasing memory deficit. Surgical outcome is also worse with longer duration of epilepsy or increasing age at surgery, which suggests that MTLE is a progressive disorder. Some emphasized the ultimate intractability of MTLE in which intractability of MTLE could be evident only after some years following initial diagnosis. However, when patients considered to have intractable epilepsy were followed up for a long period of time, many of them experienced seizure-free state. Some studies clearly demonstrated the wax and wane courses of treatment response in epilepsy. Late remission could be achieved up to in a half of patients. Thus intractable state is not a static condition but a fluctuating one and initial refractoriness does not necessarily mean the final intractability. Even though the chance of seizure remission with AEDs is not high for MTLE, some of them do well respond to drugs. It is even possible to withdraw AEDs for a few patients. Though epilepsy surgery is very effective method to treat MTLE, considering the fluctuation courses of intractability and the possibility of delayed remission, at least two adequate AEDs could be applied to the patients before surgery. However, medical intractability becomes evident by definition, it is not reasonable to delay epilepsy surgery.

No MeSH data available.


Related in: MedlinePlus

FLAIR MRI (left) and T2-weighted MRI clearly showed the left hippocampal sclerosis.
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f2-er-4-1-1-1: FLAIR MRI (left) and T2-weighted MRI clearly showed the left hippocampal sclerosis.

Mentions: Video- EEG monitoring showed brief automotor seizure followed by version to the right side and 2GTCS. Frequent independent interictal sharp waves were found in the bilateral temporal areas. Ictal EEG showed the left temporal dominant rhythmic theta activity at seizure onset. Epilepsy protocol MRI showed the left hippocampal sclerosis (Fig. 2). FDG-PET scan showed the left temporal hypomeatoblism.


Treatment strategy for the patient with hippocampal sclerosis who failed to the first antiepileptic drug.

Lee SK - J Epilepsy Res (2014)

FLAIR MRI (left) and T2-weighted MRI clearly showed the left hippocampal sclerosis.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4066627&req=5

f2-er-4-1-1-1: FLAIR MRI (left) and T2-weighted MRI clearly showed the left hippocampal sclerosis.
Mentions: Video- EEG monitoring showed brief automotor seizure followed by version to the right side and 2GTCS. Frequent independent interictal sharp waves were found in the bilateral temporal areas. Ictal EEG showed the left temporal dominant rhythmic theta activity at seizure onset. Epilepsy protocol MRI showed the left hippocampal sclerosis (Fig. 2). FDG-PET scan showed the left temporal hypomeatoblism.

Bottom Line: Thus intractable state is not a static condition but a fluctuating one and initial refractoriness does not necessarily mean the final intractability.Even though the chance of seizure remission with AEDs is not high for MTLE, some of them do well respond to drugs.It is even possible to withdraw AEDs for a few patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT
Despite many epilepsy patients respond to antiepileptic drugs (AED) successfully, more than 30% of patients continue to have seizures on multiple AEDs. The refractory epilepsy increases the risk of cognitive deterioration, psychosocial dysfunction, and sudden unexpected death of epilepsy patients (SUDEP). It is important to identify refractory epilepsy early and make the goal of epilepsy treatment as the prevention of decline in social, vocational, and cognitive performances and minimizing the risk of accident or SUDEP. The syndrome of medial temporal lobe epilepsy with hippocampal sclerosis (MTLE with HS) is often resistant to AEDs, and surgically remediable. Initially well-controlled seizures often become intractable to AEDs. There are progressive behavioral changes including increasing memory deficit. Surgical outcome is also worse with longer duration of epilepsy or increasing age at surgery, which suggests that MTLE is a progressive disorder. Some emphasized the ultimate intractability of MTLE in which intractability of MTLE could be evident only after some years following initial diagnosis. However, when patients considered to have intractable epilepsy were followed up for a long period of time, many of them experienced seizure-free state. Some studies clearly demonstrated the wax and wane courses of treatment response in epilepsy. Late remission could be achieved up to in a half of patients. Thus intractable state is not a static condition but a fluctuating one and initial refractoriness does not necessarily mean the final intractability. Even though the chance of seizure remission with AEDs is not high for MTLE, some of them do well respond to drugs. It is even possible to withdraw AEDs for a few patients. Though epilepsy surgery is very effective method to treat MTLE, considering the fluctuation courses of intractability and the possibility of delayed remission, at least two adequate AEDs could be applied to the patients before surgery. However, medical intractability becomes evident by definition, it is not reasonable to delay epilepsy surgery.

No MeSH data available.


Related in: MedlinePlus