Patterns of seizure control in patients with mesial temporal lobe epilepsy with and without hippocampus sclerosis

Abstract

Objective: Patients with mesial temporal lobe epilepsy (MTLE) may present unstable pattern of seizures. We aimed to evaluate the occurrence of relapse-remitting seizures in MTLE with (MTLE-HS) and without (MTLE-NL) hippocampal sclerosis. Method: We evaluated 172 patients with MTLE-HS (122) or MTLE-NL (50). Relapse-remitting pattern was defined as periods longer than two years of seizure-freedom intercalated with seizure recurrence. "Infrequent seizures" was considered as up to three seizures per year and "frequent seizures" as any period of seizures higher than that. Results: Thirty-seven (30%) MTLE-HS and 18 (36%) MTLE-NL patients had relapse-remitting pattern (X 2 , p = 0.470). This was more common in those with infrequent seizures (X 2 , p , 0.001). Twelve MTLE-HS and one MTLE-NL patients had prolonged seizure remission between the first and second decade of life (X 2 , p = 0.06). Conclusion: Similar proportion of MTLE-HS or MTLE-NL patients present relapse-remitting seizures and this occurs more often in those with infrequent seizures.Keywords: epilepsy, temporal lobe, seizure. RESUMOObjetivo: Pacientes com epilepsia do lobo temporal mesial (ELTM) podem apresentar padrão instável de crises epilépticas. Nosso objetivo foi avaliar ocorrência de crises remitente-recorrentes em ELTM com (ELTM-EH) e sem (ELTM-NL) esclerose hipocampal. Método: Avaliamos 172 pacientes com ELTM-EH (122) ou ELTM-NL (50). Padrão remitente-recorrente foi definido como períodos superiores a dois anos de remissão intercalados com recorrência de crises. Até três crises por ano foram consideradas como "infrequentes" e qualquer período com frequência maior como "frequentes". Resultados: Trinta e sete (30%) pacientes com ELTM-EH e 18 (36%) com ELTM-NL apresentaram crises remitente-recorrentes (X 2 , p = 0,470), mais comum naqueles com crises infrequentes (X 2 , p , 0,001). Doze pacientes com ELTM-EH e um ELTM-NL apresentaram remissão prolongada de crises entre a primeira e a segunda década de vida (X 2 , p = 0,06).

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

“…Prolonged periods of seizure freedom are observed in a substantial proportion of patients with epilepsy followed over long periods, even in those with chronic, refractory epilepsy . In a retrospective study, 30% of 122 patients with MTLE‐HS had a “relapsing‐remitting” seizure pattern . Our strict criteria may have contributed to the relatively low rates of seizure freedom observed in our population.…”

“…26 In a retrospective study, 30% of 122 patients with MTLE-HS had a "relapsing-remitting" seizure pattern. 27 Our strict criteria may have contributed to the relatively low rates of seizure freedom observed in our population. Individual seizure freedom rates per AED were too low to look at an influence of order of AED use.…”

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

“…Additionally, patients with MTLE-HS may remit and later relapse despite a period of seemingly adequate seizure control (Coan et al, 2015). Negative prognostic factors include earlier age at onset of epilepsy, bilateral or left-sided lesions, head injury at a young age, EEG abnormalities, and a large number of previously tried anti-epileptic drugs (AEDs) (Gomez-Ibañez et al, 2013; Sànchez et al, 2014).…”

Default Mode Network in Temporal Lobe epilepsy: interactions with memory performance

“…All patients had ictal semiology described by a close relative or documented by a medical staff during regular visits or during video-EEG monitoring. In addition, all had clinical and EEG features consistent with the diagnosis of MTLE according to the International League Against Epilepsy classification 21 , and had no other findings suggesting an extra temporal focal epilepsy 22 . Also, 69 healthy controls (age range 23-66, 44 females, mean age of 44 years) were enrolled.…”