Drug-resistant epilepsy: Definition and treatment alternatives

Gupta

Int J Basic Clin Pharmacol

et al. 2019

Non-compliance to medication is a prevalent and persistent healthcare problem, particularly for people with a chronic disorder like epilepsy. Approximately 21-42% of PWE show non-compliance to their prescribed treatment with AEDs. 3 ABSTRACT Background: The primary treatment for epilepsy is Antiepileptic drug (AED) therapy. Non-compliance to AEDs can result in break-through seizure, emergency department visits, hospitalizations, fractures, head injuries and increased mortality. Thus, compliance to AEDs is crucial to be studied. Objective is to study compliance and factors influencing compliance with AEDs among patients with epilepsy. Methods: This observational study was conducted in 105 patients with epilepsy on AED therapy in community in Ludhiana (Punjab) after approval from Institutional Ethics Committee. Demographic data and drug history was collected. Monthly follow up for 6 months was done by paying home visits and data regarding type, dose, frequency of administration of AED was recorded on a semi-structured performa. Pill count was done by recording number of pills dispensed and number of pills remaining with patient. Response to Morisky's Medication Adherence Scale (MMAS) was also recorded. Results were correlated with patient demographics, type, frequency and number of AEDs. Results: Out of 105 patients, 65 were males and 40 were females. Fifty-four patients were non-compliant with both pill-count and MMAS. Non-compliance was high in first month and decreased gradually. Poly-therapy, lower socioeconomic status and multiple dosing regimens were most commonly associated with non-compliance. Conclusions: Under-dosing was more common among non-compliers, which explains the high reporting of forgetfulness to take medicine in MMAS. Both pill count and MMAS are effective non-invasive tools to study compliance.

Section: Discussionmentioning

confidence: 99%

A prospective observational study to assess compliance and factors influencing compliance with antiepileptic drugs among patients with epilepsy

Gupta

Int J Basic Clin Pharmacol

et al. 2019

Zagazig University Medical Journal

“…Epilepsy was diagnosed according to ILAE criteria 2010 [12] . (1) Newly diagnosed epilepsy (NDE) (duration of less than 1 year) (2) Non-drug-resistant (NDR) epilepsy (active or occasional seizures which, improved by treatment) (3) Drug-resistant (DR) epilepsy which defined by failure of adequate trials of two tolerated, appropriately chosen and used in appropriate dose (whether as mono therapies or in combination) to achieve sustained seizure freedom that means seizure-free for more than one year, or has sporadic seizures separated by a period three times the longest interval between seizures prior to the treatment [13] . [14] .…”

Section: Methodsmentioning

confidence: 99%

Serum Matrix Metalloproteinase-2 as a Biomarker for Diagnosis of Idiopathic Epilepsy

Soliman¹,

Ebeary²,

Gouda³

et al. 2019

Background: Epilepsy is a common serious neurological disorder. Medical histories and electroencephalogram (EEG) are not always sufficient for epilepsy diagnosis; therefore, exploring novel methods for the accurate diagnosis of epilepsy is of great importance. Recent studies indicate that Matrix metalloproteinases (MMPs) especially MMP-2 is sensitive to seizures thus; MMP-2 may be a potential biomarker for epilepsy diagnosis. Subject and method: Thirty four epileptic patients older than 2 years subjected to: Detailed medical history, general and neurological examination, routine laboratory studies, EEG , Brain magnetic resonance imaging (MRI), and serum MMP-2 level measurement. Thirty four age and sex matched healthy controls were selected and their serum MMP-2 were obtained. Results: serum MMP-2 levels were statistically significantly low in patient with idiopathic epilepsy compared to control group .Levels were less in patient with focal epilepsy than those with generalized epilepsy.Serum MMP-2 was lower in drug resistant epileptic patients and highest in newly diagnosed patients with negative correlation observed between duration of epilepsy and MMP-2 levels. Sensitivity of MMP-2 as biomarker was 85.29% with 97.06 % specificity. Conclusion: MMP-2 levels decreased in patients with epilepsy especially those with focal seizures. This tool may be a helpful diagnostic biomarker for epilepsy with a good sensitivity and specificity.

“…As cirurgias para epilepsias farmacorresistentes costumam apresentar resultado satisfatório para controle de crises em até 90% das séries, porém, não devendo ser postergadas (GONZÁLEZ et al, 2015). Diversos fatores devem ser utilizados na avaliação pré-cirúrgica, visando diminuir as chances de insucesso.…”

Section: Resultados Geraisunclassified

“…O controle ineficiente de crises está associado a maior morbidade, com maior risco de morte associado às crises, traumas e redução da qualidade de vida. A definição de refratariedade é importante para melhor adequação terapêutica, assim como permite selecionar pacientes que se beneficiarão com o adequado encaminhamento para centros especializados, tratamento cirúrgico e outras medidas terapêuticas alternativas (GONZÁLEZ et al, 2015).…”

Section: Figura 1: Classificação Das Crises Epilépticasunclassified

“…De fato, vários dados sugerem que no GNT de localização temporal mesial, uma ressecção ideal inclui, além do tumor, a área epileptogênica como definida pelas correlações anatômicas e eletroclínicas realizadas nos dados ictais de vídeo-EEG, fornecendo um melhor resultado pós-operatório quando comparada à simples lesionectomia. Em casos de lateralização indeterminada do foco de CE, as investigações através de EEG invasivo podem fornecer informações úteis, embora na epilepsia focal associada ao GNT, o objetivo principal dos registros intracerebrais seja a correta determinação de áreas corticais eloquentes nas proximidades da neoplasia(GONZÁLEZ et al, 2015).Entidades diferentes (LEAT e FCD) podem ter anormalidades eletrocorticográficas semelhantes, provavelmente devido à origem comum no desenvolvimento. Curiosamente, parece que o glioma de baixo grau e as lesões não tumorais apresentam uma menor capacidade de sincronização, predispondo a uma alta ocorrência de CE e declínio cognitivo(ÇETIN et al, 2017).…”

unclassified

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Tumores associados à epilepsia

Souza¹

Introduction: Epilepsy is a chronic disease and affects up to 80 million people worldwide. About two-thirds of these patients are in middle and low-income. Refractory epilepsy can occur in 20 to 30% of patients. Structural brain lesions are the principal cause of refractory epilepsy. In particular, brain tumors are the second etiology that requires surgery in specialized epilepsy centers. Furthermore, low-grade tumors have a higher epileptogenic potential compared to those of high-grade tumors associated with epilepsy. The dysembryoplastic neuroepithelial tumor (DNT) and ganglioglioma correspond to the foremost found in clinical cohorts. Objective: Evaluate the surgical outcome in patients undergoing epilepsy surgery by brain tumors. Materials and methods: A sample of 86 patients undergoing epilepsy surgery were selected, between 0 and 60 years old, who underwent preoperative evaluation with Video-EEG, and the histopathologic result was tumor. Results: 38 patients were aged from 19 years old; 48 patients were aged below 19 years old. The most prevalent histological type was DNT with 37.2% followed by ganglioglioma with 22.1%. The main site of involvement was the temporal lobe, accounting for 66.3% of all series. The rate of patients classified as Engel I was 77.9% in the first year and 74% in the fifth year of follow-up. Normal EEG-based activity, Semiologic concordance and ictal EEG concordance were associated with the best result. The use of invasive EEG did not alter the prognosis. In the multivariate analysis between the variable ictal EEG, Interictal EEG, semiology and backgroud activity, the last normal was associated with favorable outcome (p = 0.012). Isolated lesionectomy was associated with worse results in seizure control. Conclusion: The electroencephalographic data present an important predictive value in the presurgical evaluation. A broader surgery (enlarged lesionectomy) or lobectomy was associated with better outcome, as well as the presence of temporal surgery presented a better outcome in relationship to non-temporal surgeries.