The Prognosis for Control of Seizures with Medications in Patients with MRI Evidence for Mesial Temporal Sclerosis

Kim, Won Joo; Park, Soo-Chul; Lee, Se-Jin; Lee, Joon-Hong; Kim, Jung-Yeon; Lee, Byung-In; Kim, Dong Ik

doi:10.1111/j.1528-1157.1999.tb00706.x

Cited by 92 publications

(79 citation statements)

References 21 publications

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“…10,13,15,[19][20][21][30][31][32][33][34] In general our findings agree with the results of previously published studies. Similar to our findings previous studies have also reported that patients with partial epilepsy have a greater chance to develop drug-resistant epilepsy than patients with generalized epilepsy.…”

Section: Resultssupporting

confidence: 93%

“…19 A yet unresolved debate is whether the number of past seizures or the etiology of epilepsy and especially hippocampal atrophy carry a prognostic value. 13,19,21,[30][31][32][33] With respect to the etiology of epilepsy we found no significant difference between patients with cryptogenic (remote symptomatic) and symptomatic epilepsy. 32 However, we did not examine specific causes of symptomatic epilepsy, as the small number of patients with each specific etiology (for example our cohort included 29 cases with hippocampal atrophy and 25 cases with cortical dysplasia) precluded us from controlling for the past AED treatment history for each specific etiology.…”

Section: Resultsmentioning

confidence: 52%

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Quantifying the response to antiepileptic drugs

Schiller¹,

Najjar²

2008

Neurology

300

182

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Drug resistance is a graded process that follows a mono-exponential course with a half-decay constant of 1.5 to two antiepileptic drugs (AEDs). Although relative drug-resistant epilepsy can be diagnosed after failure of two past AEDs, absolute drug resistance requires failure of six AEDs, as a significant minority of patients (16.6%) is rendered seizure-free by addition of newly administered AEDs even after failure of two to five past antiepileptic drugs.

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Section: Resultssupporting

confidence: 93%

Section: Resultsmentioning

confidence: 52%

Quantifying the response to antiepileptic drugs

Schiller¹,

Najjar²

2008

Neurology

300

182

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“…The quantity of interictal spikes is predictive of severity in temporal lobe epilepsy [19]. Oligospikers, patients with temporal lobe epilepsy with less than 1 spike per hour, correlate with less severe epilepsy [20].…”

Section: Predictive Factors Of Refractorinessmentioning

confidence: 99%

Refractory Epilepsy: A Clinically Oriented Review

Beleza

2009

Eur Neurol

101

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About one third of patients with newly diagnosed epilepsy do not achieve seizure control despite medical therapy and should be assessed in detail to confirm the diagnosis, to determine the epilepsy syndrome and to plan treatment strategy. Refractory epilepsy is established when there is inadequate seizure control despite using potentially effective antiepileptic drugs (AEDs) at tolerable levels for 1–2 years, and excluding nonepileptic events and poor compliance. An overview of patient management in everyday clinical practice is given. Risk factors for refractoriness include (1) generalized epilepsy with lesions; (2) focal epilepsy with hippocampal sclerosis, cortical dysplasia or hemorrhages; (3) early epilepsy onset; (4) high seizure frequency; (5) absence of response to the first 2 AEDs; (6) high frequency of interictal spikes, and (7) multifocal spikes. The efficacy of surgery ranges from curative (resection) to palliative (vagus nerve stimulation, callosotomy, multiple subpial transections) depending on the epilepsy syndrome and etiology. Using a new antiepileptic drug benefits about one third of patients. Refractoriness is constitutive in most patients and shows a progressive or remission-relapse course in others. As the transporter and target hypotheses do not entirely explain refractoriness, other hypotheses are emerging. New treatments under investigation are described.

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“…In particular, hippocampal sclerosis and cortical dysgenesis were important indicators of a poor prognosis, whereas seizures in patients who had strokes, vascular malformations, or tumors were more likely to be controlled. However, other studies have found a better outcome for patients with medial temporal lobe epilepsy (MTLE), indicating an heterogeneous clinical presentation for patients with MR-detected mesial temporal sclerosis (14,15). Thus none of these markers is especially sensitive or specific for refractory epilepsy.…”

mentioning

confidence: 99%

Is Refractory Epilepsy Preventable?

et al. 2002

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Summary: About a third of the patients diagnosed with epilepsy will not be fully controlled with antiepileptic drugs (AEDs), and many of them will have frequent and disabling seizures. These patients will undergo multiple drug trials, most often without complete seizure remission. Moreover, refractory epilepsy is associated with increased morbidity (from seizures and medications), social isolation, unemployment, and overall reduced quality of life. There is evidence that refractory epilepsy can be a progressive disorder, which, if controlled early, might never develop into a full syndrome with all of its associated sequelae. The difficulty lies in identifying at an early stage patients who are likely to progress to intractability. No currently known markers enable clinicians to make this identification with confidence. Advances in pharmacogenomics and our understanding of pharmacologic responsiveness in epilepsy may change this situation. Even now, we are able to identify many patients with a poor prognosis earlier than before, particularly in the pediatric population, in which syndromic classification may provide an approach to predict intractability. The early initiation of aggressive therapy may improve outcome and overall quality of life.

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The Prognosis for Control of Seizures with Medications in Patients with MRI Evidence for Mesial Temporal Sclerosis

Abstract: Not all patients with MTS are medically intractable; 25% of the patients in our study achieved complete control while receiving medication. Poor seizure control was related to an early age of seizure onset, a history of febrile convulsions, and epileptiform discharges on the EEG.

Cited by 92 publications

References 21 publications

Quantifying the response to antiepileptic drugs

Quantifying the response to antiepileptic drugs

Refractory Epilepsy: A Clinically Oriented Review

Is Refractory Epilepsy Preventable?

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