Abstracts

Rationale: Malformations of cortical development(MCD) are an important cause of epilepsy. The vast majority of such patients are not candidates for resective epilepsy surgery. There is a paucity of data on the seizure outcome in patients with epilepsy and MCD who are primarily managed by antiepileptic medications(AEDs). This is the most relevant data needed by clinicians treating such patients. The studies available primarily analyze the surgical outcome in patients with epilepsy and MCD. In this retrospective study, we intend to determine the seizure outcome in epilepsy patients with MCD who are primarily treated by AEDs. Methods: This is a retrospective study involving over 1400 patients treated for epilepsy at The Nebraska Epilepsy Center at UNMC. We searched in our database for patients with MCD who met both of the following inclusion criteria. 1. Adult patients with seizures. (Age above 18 years). 2.Diagnosis of MCD on Neuroimaging studies. Based on the above inclusion criteria 19 patients were included in the study. All 19 patients were under medical therapy with AEDs. On an average these patients had failed 4 AEDs in the past. DEMOGRAPHIC DATA: oSize: 19 patients. oAge: 19-58 years. oSex: Males - 10, Females - 9. oDuration: 2002 - April 2008. Minimum follow up time was one year at the least. The seizure outcome was classified as follows: oCLASS I: Seizure free at the last visit oCLASS II :> 75 % reduction in seizure frequency. oCLASS III: ≥ 50% reduction in seizure frequency. oCLASS IV :< 50% reduction in seizure frequency. Patients in CLASS IV were designated as treatment failures. Out of the 19 patients, 2 had failed vagus nerve stimulation and 1 had failed epilepsy surgery. Results: 13 out of 19 patients (68.42%) with MCD and epilepsy had a greater than 50% reduction in seizure frequency. 6 out of 19 patients (31.58%) became seizure free. OUTCOME: CLASS I - 6 patients (31.58%) CLASS II - 5 patients (26.31%) CLASS III - 2 patients (10.52 %) CLASS IV - 6 patients (31.58%) Seizure outcome was also analyzed in the different types of MCD and the results were as follows: oHeterotopias alone: 82% reduction in seizures. oHeterotopias along with other cortical malformations: 78% reduction in seizures. oPolymicrogyria: 62% reduction in seizures. oOther MCDs (lissencephaly, schizencephaly etc.):< 50% reduction in seizures. Conclusions: In this retrospective study of ours, which included adult patients with epilepsy and MCD we found that 13 out of 19 patients (68.42%) had greater than 50% reduction in seizure frequency when treated primarily by AEDs. 6 out of 19 patients (31.58%) became seizure free. This retrospective study shows that adult patients with epilepsy and MCD do attain significant seizure control with treatment by AEDs. Larger multi-center studies are needed to confirm these findings and to explore the unique efficacy profiles of different AEDs in this subgroup of epilepsy patients.