Abstracts

Rationale: CBZ and VPA are always the first line AED for focal seizures (FS), however, some FS do not respond to them. What to do next? We studied on the type of CBZ or VPA-unresponsive FS in non-idiopathic and nonlesional focal epilepsies (NINLFE) and effective AEDs for such seizures.Methods: Patients with NINLFE, aged 2-40 years, treated by the author (KS) for at least one year or longer at a tertiary epilepsy center were selected and their medical records were retrospectively reviewed. Some patients had more than one seizure types.Results: CBZ and VPA were administered to 291 seizures in 216 cases (frontal lobe epilepsy, 177, temporal lobe epilepsy, 24, parietal/occipital lobe epilepsy, 15) and 284 seizures in 192 cases (frontal lobe epilepsy, 158, temporal lobe epilepsy, 22, parietal/occipital lobe epilepsy, 12), respectively. Responders (seizure reduction by >50%) to CBZ and VPA were, in total, 112/291 and 60/284 seizures: 10/113 and 29/137 in tonic seizures (TS), 26/50 and 9/64 in secondarily generalized tonic-clonic seizures (sGTCS), 18/23 and 5/26 in clonic seizures (CS), 12/13 and 3/10 in hypermotor seizures (HS), 6/22 and 6/35 in atonic falling (AF) by negative motor seizures and anterior frontal pole seizures, 32/50 and 7/54 in dyscognitive seizures (DS), and 7/16 and 1/14 in sensory or autonomic seizures (SAS). Non-responders were treated with other antiepileptic drugs (AEDs). Responder rates (RR) of AEDs which administered to 10 or more cases (11-87 cases) of non-responders to CBZ were >75% in LTG, KBr, ZNS for TS; ZNS for sGTCS; ZNS for AF; none for DS. RR=74-50% in PB, CLZ, PHT for TS; PB, CZP for sGTCS; none for AF; CLB for DS. RR<25% in AZM, VPA, TPM, LEV for TS; VPA for sGTCS; VPA for AF; none for DS. RR of AEDs for 10 or more non-responders (10-74 cases) to VPA were >75% in LTG, KBr for TS; KBr, ZNS for sGTCS; none for AF; ZNS for DS; ZNS for CS. RR=74-50% in ZNS, AZM, CLB for TS; CBZ for sGTCS; none for AF; PHT, CZP for DS; CBZ for CS. Only 16/129 non-responder to CBZ responded to VPA, and 46/159 non-responders to VPA responded to CBZ.Conclusions: Though CBZ and VPA are the first line AED, CBZ- or VPA-unresponsive FS are many and their frequency is different among seizure types. Their effective AEDs are different by seizure types, and simple switch between these two AEDs may not be effective.