Abstracts

This study is intended to reveal to select treatment modalities by reviewing our experiences in intractable childhood epilepsy.
This is a clinical retrospective study performed for 7 years from Oct. 1995 to Oct. 2002 at the epilepsy center of our hospital. Subjects were selected those could not be controlled by initial two or three conventional antiepileptic drugs in any type of epilepsy or epileptic syndrome of childhood. According to their known indications, therapeutic modalities had been introduced in order of newly developed anticonvulsants, hormone therapy, ketogenic diet and epilepsy surgery or VNS, sometimes together or repeatedly. We analyzed the outcomes of individual treatment modalities for intractable childhood epilepsy.
One hundred seventy five patients out of 297 patients enrolled to this study were male and 122 patients were female. The mean age of patients at beginning of seizures was 23.9 months(SD[plusmn], 33.6) old and mean duration of seizures was 66.2 months(SD[plusmn], 42.5). Eighty four(28.3%) patients were diagnosed with Lennox-Gastaut syndrome including 24(7.7%) started with Infantile spasms, 77(25.9%) with Infantile spasms, 78(26.2%) with partial seizures, 21(7.1%) with severe myoclonic epilepsy of infancy, 9(3.0%) with Landau-Kleffner syndrome, 4(1.3%) with myoclonic [amp] astatic seizure, 4(1.3%) with early infantile epileptic encephalopathy, 1(0.3%) with periodic spasm and 19(6.0%) with other types generalized epilepsy.
By newly developed anticonvulsants only, 13 patients(4.4%) could have been seizure free. Among 151 patients who had been on hormone therapy, 66 patients had been completely controlled but only 17 patients could maintain the effect. Among 171 patients who tried ketogenic diet, in 64 patients ketogenic diet have been continued or finished with seizure reduction by more than 50% including 39 patients with seizure free. Twenty six patients had finished ketogenic diet with seizure free but 7 patients showed relapse. Epilepsy surgery had been executed in 38 patients and the results were as follows, Engel class I in 25 patients including temporal lobe epilepsy(TLE) in 5 patients, Engel II in 4 patients including TLE in 2 patients, Engel III in 2 patients, Engel IV in 6 patients including TLE in 1 patient and vegetative state in 1 patient. VNS had been set up in 5 patients and only 3 patients obtained seizure reduction by more than 50%.
Collectively, among 152 patients could be followed up until to the end and for more than 6 months since the last therapeutic modality was introduced, in 100 patients seizure have been completely controlled.
Intractable childhood epilepsies can considerably be controlled through various therapeutic modalities, especially ketogenic diet and epilepsy surgery of well localized epileptic focus. However, hormone therapy has somewhat more frequent relapse rate and newly developed anticonvulsant has some limit to control intractable childhood epilepsy.