327
Views
7
CrossRef citations to date
0
Altmetric
Clinical Focus: Neurological & Psychiatric Disorders - Original Research

Drug-responsive versus drug-refractory mesial temporal lobe epilepsy: a single-center prospective outcome study

, , , &
Pages 479-485 | Received 30 May 2019, Accepted 30 Aug 2019, Published online: 12 Sep 2019
 

ABSTRACT

Objectives: To evaluate clinical, electrophysiological, and neuroradiological factors which correlate with the prognosis in patients with mesial temporal lobe epilepsy (MTLE).

Methods: This was a single-center prospective outcome study in patients with MTLE. The patients’ family history, clinical characteristics, neurophysiological data (electroencephalography – EEG), neuroimaging, antiepileptic therapy, and outcome were collected and analyzed. The population was divided into four groups depending on the frequency of the seizures when they attended their last follow up. All variables and outcome measures were compared between the four groups.

Results: In total 83 consecutive patients were included within the four groups. Group 1 (seizure-free) consisted of 7 patients, (9%), Group 2 (rare seizures) consisted of 15 patients (18%), Group 3 (often seizures) consisted of 30 patients (36%), and Group 4 (very often seizures) consisted of 31 patients (37%). The groups did not differ significantly in demographic characteristics. There was a strong positive correlation between resistance to therapy and sleep activation on EEG (p = 0.005), occurrence of focal to bilateral seizures (p = 0.007), automatisms (p = 0.004), and the number of previously used antiepileptic drugs (AEDs) (p = 0.002). There was no association between febrile convulsions (FC), hippocampal sclerosis (HS), and the outcome that was found.

Conclusion: MTLE is a heterogeneous syndrome. Establishing the factors responsible for, and associated with, drug resistance is important for optimal management and treatment, as early identification of drug resistance should then ensure a timely referral for surgical treatment is made. This prospective study shows that sleep activation on EEG, ictal automatisms, occurrence of focal to bilateral tonic-clonic seizures, and increased number of tried AEDs are negative prognostic factors.

Acknowledgments

The authors would like to thank Miss Laura Williamson, Frimley Park Hospital NHS Foundation Trust for kindly reviewing the final version of the document and proofreading its content.

Declaration of interest

Peer reviewers and the authors of this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.