Abstracts

Rationale: Treatment of non-idiopathic partial epilepsies (NIPE) is traditionally based on the seizure (Sz) type of simple partial, complex partial and secondarily generalized seizures, however, this often fails to obtain good Sz control, particularly in chronic epilepsy. We have reported that the effective AEDs differ among precise seizure symptoms (PSSs) in NIPE by retrospective study of 209 cases of NIPE including 200 cases of chronic epilepsy, that were treated for one year or longer (28th IEC, Budapest, 2009). They consisted of 170 cases of frontal lobe epilepsy (FLE), 28 cases of temporal lobe epilepsy (TLE), and 11 cases of parietal or occipital lobe epilepsy (PLE/OLE). 127 cases had one PSS, 70 cases had two PSSs and 12 cases had three PSSs. AEDs with excellent responder rate (RR>75%: E-RR), good RR (RR=50-74%: G-RR) and poor RR (RR<25%: P-RR) were analyzed in AEDs administered to > 10 cases for each PSS. AEDs with E-RR, G-RR and P-RR for tonic Sz (total 405 trials) were ZNS/potassium bromide (KBr), PB/PHT/CLZ, and CBZ/VPA, respectively. AEDs with these were: for secondarily generalized tonic-clonic Sz (122 trials), ZNS/CZP, PB/PHT/CBZ, none; for clonic Sz (56 trials), CBZ, none, none; for hypermotor Sz (93 trials), PHT, CBZ, ZNS/VPA; for atonic or negative myoclonic seizure (103 trials), ZNS/PB, none, CBZ/CLB/CZP/VPA; altered consciousness or motion arrest (82 trials), CLB/CBZ, CZP, VPA; others including sensory or non-tonic versive seizures (39 trials), none, CBZ, none. To confirm these results, prospective study was conducted. Methods: Another 83 cases with chronic NIPE, consisted of 70 cases of FLE, 5 cases of TLE and 8 cases of PLE/OLE, were prospectively treated for six months or longer with AEDs with E-RR and G-RR for each PSSs obtained from the retrospective study. Results: The 50% or greater Sz reduction was obtained in tonic Sz in 38/40 trials with ZNS, 13/13 with KBr, 19/26 with PB, 7/15 with PHT and 4/4 with CLZ. This reduction was obtained in secondarily generalized tonic-clonic Sz in 6/8 with ZNS, 0/1 with CZP, 7/8 with PB and 3/9 with CBZ; in clonic Sz, 10/11 with CBZ; in hypermotor Sz, in no trial with PHT and 0/1 with CBZ; in atonic or negative myoclonic seizure, in 12/12 with ZNS, 1/2 with PB; in Sz showing altered consciousness or motion arrest, in 6/13 with CBZ, 6/10 with CLB and 1/4 with CZP; in sensory Sz or others, in 2/4 with CBZ. Conclusions: Although more cases are needed to make results firmly, particularly for hypermotor Sz, Sz of altered consciousness or motion arrest, and sensory Sz or others, the present prospective study essentially confirmed the results of the previous retrospective study that the effective AEDs for NIPE were different among PSSs and which AEDs were effective for each PSS. These findings may improve pharmacotherapy of NIPE.