Abstracts

Rationale: A national program for evaluation and surgery for epilepsies was set up in Brazil in 1994. Thousands of patients had access to surgical treatment since then. We present the current profile of the patients evaluated in the last four years in one major center.Methods: All patients are admitted for a standardized evaluation consisting of 32 channel video-EEG, 1.5 T MRI scan (with reformatting capabilities), neuropsychological testing, psychiatric evaluation and laboratory tests including anticonvulsant levels. We reviewed the consolidated information of each individual case evaluated in the last four years (2011-2014). We present demographic data, final diagnosis and recommendations (surgery, clinical treatment, neuromodulation or further investigations such as invasive electrodes, PET, amytal test, etc).Results: Seven hundred and three patients were evaluated, aging from 1 to 75 years, referred from 22 (out of 26) Brazilian states during the last four complete years. Surgery was indicated for 48%; 29% did not meet surgical criteria; 13% needed further investigations and 9% were indicated either vagus nerve or deep brain stimulations. Incidence of non-epileptic seizures was 10 %; mesial temporal sclerosis accounted for 36%; malformations of cortical development 8%. Most performed surgeries were antero-mesial temporal resections (n=201), corpus callosotomies (n=52), lesionectomies (n=46) and hemispherectomies (n=16).Conclusions: A simple investigation protocol is sufficient for establishing a diagnosis and indicating the most appropriate treatment for 87% of the cases referred for refractory seizures. This should encourage the multiplication of centers with intermediate resources in developing countries. The options of neuromodulation have widened the therapeutic arsenal in recent years, with interesting results.