DOES REMISSION OF SEIZURES PREDICT A BETTER PROGNOSIS IN TEMPORAL LOBE EPILEPSY DUE TO MESIAL TEMPORAL SCLEROSIS?
Abstract number :
1.288
Submission category :
Year :
2003
Submission ID :
2209
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Flavia S. Miyashira, Alexandre Pieri, Domingos S.S. Vieira, Luis O.S.F. Caboclo, Eliana Garzon, Americo C. Sakamoto, Elza M.T. Yacubian Unidade de Pesquisa e Tratamento das Epilepsias, Escola Paulista de Medicina,Universidade Federal de Sao Paulo, Sao Pau
The natural history of temporal lobe epilepsy (TLE) related to mesial temporal sclerosis (MTS) remains unknown, including how long it takes to become intractable. The aim of this study was to assess the association between period of remission and intractability of seizures in adult patients with MTS, who fulfilled our criteria of intractability and were eligible for pre-surgical video-EEG evaluation.
In this population we sought for a history of remission as well as the time of the initial event, if present, and the time left for intractability. In order to be eligible, patients were required to have clinical and routine EEG findings suggestive of medial temporal lobe involvement and unequivocal signs of MTS without any other intracerebral lesion on MRI. Intractability was considered a failure of monotherapy defined as no response at maximum tolerated dosages of first line drugs. Remission was the time period of at least one year seizure-free between the second unprovoked seizure and diagnosis of intractability.
Of 121 patients diagnosed as MTS, 57 were enrolled as intractable TLE and were included in the present analysis. 11 out of 57 patients (19.2%) presented at least one period of remission, which occurred 2.7[plusmn]4.7 years after the second unprovoked seizure. The duration of the remission period varied from 1 to 27 years (10.7[plusmn]7.5) and 22 out of 57 (38.6%) presented an initial event. The time between the second unprovoked seizure and the establishment of intractability was 26.6[plusmn]10.8 years and the time between the initial event and intractability, 36.5[plusmn]10.7 years.
About 1/5 of our refractory patients with MTS experienced one seizure-free period mainly in the first years of the disease lasting from one year to approximately three decades, which is in accordance with previous data reported in other series of patients with partial seizures (Berg et al., 2003). We therefore infer that remission time may neither imply in a better prognosis nor signify control. Patients who are considered seizure-free may just be at their time-limited remission period, which may be followed by a non-return way until intractability. How we will restrain this sequence is a matter for further research.
[Supported by: FAPESP-Funda[ccedil][atilde]o de Amparo [agrave] Pesquisa do Estado de S[atilde]o Paulo.]