Does the Cause of Localisation‐Related Epilepsy Influence the Response to Antiepileptic Drug Treatment?

Abstract

Summary:Purpose: We investigated the response to antiepileptic drug (AED) therapy in patients with localisation-related epilepsy associated with different underlying causes.Methods: Five hundred and fifty adolescent and adult patients who had partial epilepsy treated with AEDs and who had undergone magnetic resonance imaging of brain were followed up prospectively from 1984 at a single centre. More than 70% were newly diagnosed. None had had epilepsy surgery.Results: Three hundred and twelve (57%) patients had been seizure free at their last clinic visit for at least a year. Patients with mesial temporal sclerosis (MTS; n ‫ס‬ 73, 42% seizure free) were less likely to be controlled (p < 0.01) than were those with arteriovenous malformation (AVM; n ‫ס‬ 14, 78%), cerebral infarction (n ‫ס‬ 46, 67%), primary tumour (n ‫ס‬ 35, 63%), cortical gliosis (n ‫ס‬ 81, 57%), cerebral atrophy (n ‫ס‬ 49, 55%), and cortical dysplasia (CD; n ‫ס‬ 63, 54%). Among the seizurefree patients, those with MTS were more likely to require more than one AED compared with those with other aetiologies (48 vs. 35%; p < 0.05). There was no difference in outcome between patients with symptomatic and cryptogenic epilepsy (n ‫ס‬ 361, 58% vs. n ‫ס‬ 189, 56% seizure free, respectively). Patients with MTS, CD, and cryptogenic epilepsy were more likely (p ‫ס‬ 0.02) to have a family history of epilepsy than were the other groups. MTS patients also had a higher incidence of febrile convulsions (p < 0.001).Conclusions: The majority of patients with focal-onset epilepsy became seizure free on AED treatment. MTS-related seizures had the worst prognosis. Although many patients with this pathology may benefit from epilepsy surgery, a considerable number will be controlled with AED therapy.

Use of chromosome substitution strains to identify seizure susceptibility loci in mice

“…Most common forms of epilepsy are not explained by the genes discovered so far, and their genetics appears to be "complex," resulting from multiple genes of small to moderate effect. Temporal lobe epilepsy (TLE), a common type of epilepsy that is frequently refractory to medical therapy, presents similar challenges because of its genetic complexity (Engel 2001;Fuerst et al 2001; Semah et al 1998; Stephen et al 2001). …”

Is Refractory Epilepsy Preventable?

“…A number of "markers" have been advanced as indicators of refractory epilepsy, including age at onset (younger than 1 year) (10), type of epilepsy (e.g., partial epilepsies or catastrophic epilepsies of childhood) (5,11,12), failure of the first AED (5,6), use of more than two drugs (5), and duration of treatment without achieving control (11). The presence of certain brain lesions also is an important marker for refractory epilepsy (11,13). In a cohort of 2,200 adults with epilepsy, intractable seizures were much more frequent in patients with brain abnormalities on magnetic resonance imaging (MRI) than in those without such findings (11).…”

Announcements

“…First, generally speaking, observational studies have known methodologic limitations: they are often conducted in tertiary centers, generating a selection bias toward more severe epilepsy patients, and they lack a control group. Second, in our opinion, the observational studies 2,3 cited in our paper and in that of Zelano 3 do not challenge the notion that PSE carries a good prognosis. Indeed, the study by Semah et al 2 was conducted on patients with focal lesional epilepsy, and PSE had the best prognosis when compared to symptomatic epilepsy from other causes.…”

“…Indeed, the study by Semah et al 2 was conducted on patients with focal lesional epilepsy, and PSE had the best prognosis when compared to symptomatic epilepsy from other causes. In the work by Stephen et al 3 on localization-related epilepsies, almost 70% of patients with cerebral infarction achieved seizure freedom. This percentage was only inferior to the proportion of seizure-free patients with arteriovenous malformation.…”