Very Long-Term Outcome of Non-Surgically Treated Patients with Temporal Lobe Epilepsy with Hippocampal Sclerosis: A Retrospective Study

Abstract

ObjectiveSurgical intervention can result in complete seizure remission rates of up to 80% in patients with temporal lobe epilepsy with hippocampal sclerosis (TLE-HS). However, certain patients cannot be treated surgically for various reasons. We analyzed the very long-term clinical outcomes of patients with TLE-HS who could not be treated surgically.MethodsSubjects were selected from among patients with TLE-HS who were actively followed up for >10 years and treated with medication without surgical treatment. Patient medical records were used to retrospectively study seizure frequency, various clinical factors, and social adjustment. Patients who were seizure-free or had only aura were classified into Group 1; the others were classified into Group 2. Clinical factors including both patient and disease-specific factors were compared between the two groups. Current social adjustment, including the education, work, and economic status of each patient, was also investigated.ResultsForty-one (41) subjects met the criteria for analysis, of which 12 (29%) were classified into Group 1. The average age of patients in Group 1 was higher than that of Group 2 (p = 0.0468). Group 2 included a significantly higher rate of patients who had more than one seizure per week at the onset (p = 0.0328), as well as a greater mean number of anti-epileptic drugs taken (p = 0.0024). Regarding social adjustment, Group 2 contained significantly fewer current jobholders than Group 1 (p = 0.0288).ConclusionsAfter very long-term follow-up periods, 29% of patients with TLE-HS had a good outcome through treatment with anticonvulsant medications. Older patients tended to have fewer seizures, and seizure frequency at the onset was the only factor that predicted outcome.

Treatment response and its predictors among epilepsy patients: a retrospective cohort study

“…We demonstrated that patients with a high frequency of pre-treatment seizure were associated with poor treatment seizure remission (AHR 0.716, 95% CI 0.558, 0.919). In accordance with the present results, previous studies have demonstrated that a higher pre-treatment seizure frequency has been repeatedly associated with a lower chance of remission [19][20][21][22][23][24]. The role of the number of pre-treatment seizure was based on the theory that prolonged and recurrent seizure caused neuronal damage and the development of new epileptic foci [25].…”

Comparative effectiveness of antiepileptic drugs in patients with mesial temporal lobe epilepsy with hippocampal sclerosis

“…In a study of 110 patients with MTLE‐HS, 31% remained seizure‐free for at least 2 years . A similar although smaller study reported 29% of 41 patients with MTLE‐HS as being seizure‐free or having only focal aware seizures . These two studies were conducted in nonsurgical cases only.…”

“…20 A similar although smaller study reported 29% of 41 patients with MTLE-HS as being seizure-free or having only focal aware seizures. 21 These two studies were conducted in nonsurgical cases only. In contrast, our cases were mostly patients with longstanding disease recruited mainly from tertiary referral centers.…”

Pharmacoresistance with newer anti-epileptic drugs in mesial temporal lobe epilepsy with hippocampal sclerosis

“…The definitive treatment for refractory MTLE-HS is surgical, with approximately 70–80% of patients achieving seizure freedom post-operatively (Kim et al, 1999; Malmgren and Thom, 2012). Patients may be managed medically if not surgical candidates due to extrahippocampal pathology or if surgery is not an option due to financial constraints (Kurita et al, 2016). …”

“…Several studies have examined the prognostic factors associated with the success of medical therapy in MTLE-HS, finding that such treatment results in complete remission in only 5 to 42% of patients, a percentage much lower than that for other forms of epilepsy (Giussani et al, 2016; Kim et al, 1999; Kumlien et al, 2002; Kurita et al, 2016; Kuzmanovski et al, 2016; Semah F et al, 2002; Stephen et al, 2001). Additionally, patients with MTLE-HS may remit and later relapse despite a period of seemingly adequate seizure control (Coan et al, 2015).…”