Abstracts

RATIONALE:. Seizures originating in the limbic system of temporal lobe epilepsy (TLE) probably have a different pathophysiology than those due to extra-temporal lobe partial epilepsy (EXTLE), and therefore may respond to different antiepileptic drugs (AED). This exploratory study examined current AED use for patients with TLE compared to EXTLE. We hypothesize that patients with TLE respond to different AEDs than those with EXTLE. METHODS: A retrospective analysis was performed on data collected from a controlled database of epilepsy patients seen in our clinic. Patient demographics, etiology, seizure type, family history, EEG, neuroimaging, and response to therapy were gathered on each patient to determine ILAE seizure types and epilepsy syndromes. All patients with a diagnosis of a localization related epilepsy syndrome on one or more AEDs were included. Patients were divided by clinical diagnosis into either TLE or EXTLE. Chi square analysis was used to compare differences between EXTLE and TLE for age, gender, number of medications, AED monotherapy and for current use of the following AEDs: phenobarbital, phenytoin, carbamazepine, valproate, gabapentin, and lamotrigine. RESULTS: Of the 780 patients in the database, a total of 400 (TLE=77, EXTLE=323) children and adults met the inclusion criteria. The TLE group was older (34(13) than the EXTLE group(28.8(18; p=0.008) and were on more medications (TLE=2.1(1.01; EXTLE=1.6(0.9; p<0.001). There was no gender difference between groups. EXTLE patients were more likely to be on monotherapy (54%) than TLE (38%; p=0.008). TLE patients were more likely to be on phenytoin (p=0.02) and lamotrigine (p<0.001). No differences were found between the two groups for carbamazepine, gabapentin, phenobarbital, or valproate. CONCLUSIONS: TLE patients are currently on more concomitant AEDs and are less likely to be on monotherapy, suggesting TLE is harder to control than EXTLE. The increased use of lamotrigine and phenytoin may suggest that seizures of limbic origin may respond better to these drugs, although a systematic study would be needed to demonstrate this.