Abstracts

Rationale: More and more antiepileptic drugs (AEDs) become available, however, considerable numbers of epilepsies are still intractable. Most of the reports on the efficacy of a particular AED are based on the treatment for patients with newly diagnosed epilepsy, and a few have been reported regarding its efficacy for intractable epilepsies. Partial seizures are traditionally classified as simple partial, complex partial and secondarily generalized, however, this classification is not useful for the treatment of intractable epilepsies. We studied whether effective AEDs for intractable partial epilepsies are different among seizure symptoms. Methods: Based on a widely accepted definition of intractability that the epilepsy is intractable when it has failed to two appropriate AEDs, we analyzed the efficacy of AEDs for actual seizure symptoms (ASS) described below in 289 cases of chronic non-idiopathic partial epilepsies, aged 2 and 35 years, that had not achieved seizure freedom by one year or longer treatment with two AEDs and treated with the third or further AEDs. They consisted of 240 cases of frontal lobe epilepsy, 29 cases of temporal lobe epilepsy, and 20 cases of parietal or occipital lobe epilepsy. There were one ASS in 146 cases, two ASSs in 123 cases and three ASSs in 20 cases. ≧50% responder rate (RR) were obtained for each AED administered in ≧10 cases in each ASS, and RRs were classified as excellent (E-RR: RR≧75%), good (G-RR: RR=50-74%), fair (F-RR: RR=25-49%) and poor RR (P-RR: RR<25%). Results: AEDs with E-RR, G-RR, F-RR and P-RR for tonic Sz after a total of 855 trials were bromide/ZNS, PB/ CLZ/LTG/PHT, TPM/CZP/AZM, and CLB/LEV/VPA/CBZ/GBP, respectively. AEDs with these were: PHT/CZP/ZNS/PB, CLB/TPM/CBZ, LTG/VPA, and none, for secondarily generalized tonic-clonic Sz (234 trials); CBZ/CLB, CZP/PHT, none, and VPA, for clonic Sz (103 trials); PHT, CBZ, LTG/CZP, and ZNS/VPA, for hypermotor Sz (107 trials) ; ZNS, PB, none, and CBZ/CLB/VPA/CZP for atonic or negative myoclonic seizure of frontal origin or negative motor area Sz (172 trials); CLB, CBZ/CLZ, CZP, and VPA/ZNS, for altered consciousness and/or motion arrest (156 trials); and none, CBZ, none, and none, for sensory or autonomic seizures (71 trials). Conclusions: CBZ and VPA are first and commonly used for partial seizures, however, they do not respond to all partial seizures, and particularly VPA does not respond to intractable partial epilepsies. Although more cases are needed to make the present results firmly, the present study indicates that effective AEDs for intractable partial epilepsies are different among ASS, and suggests that AEDs choice, depended on not merely partial seizure but ASS, is effective way for the treatment of intractable partial epilepsies.