Abstracts

Rationale: The symptomatic generalized epilepsy are usually characterized by the presence of tonic and atonics crisis, many times leading the patient to sudden fall on the ground. When it happens, we call these seizures Drop Attacks. Such seizures happen in at least 50% of the cases of Lennox-Gastaut syndrome and probably in 2-3% of an epileptic population. The treatment of this seizures is usually disappointing. This study intends to evaluate the efficacy of a medicinal scheme well determined, composed by the association of three antiepileptic drugs, aiming to control a type of epileptic seizures, the sudden fall seizures or drop attacks Methods: We evaluated, until the present moment, a consecutive group of 21 patients with drop attacks, that attended to the Epilepsy Ambulatory of São Lucas Hospital of PUCRS.Such patients were evaluated from the clinical point of view, of electroencephalografic and of neuroimage. All of them have passed through a drug adjustment period, where the drugs in use were reduced and taken off, as we slowly introduced the association of valproate, lamotrigine and a benzodiazepine (clobazam, clonazepam or nitrazepam). The visits were every three months, during the period of less than one year. Results: The group was composed by 21 patients, being 9 (42.8%) adults, 15 (71%) from the male sex, and 6 from the female, with a medium time of epilepsy of 13.3 years. All the patients were dependents, due to changings in their neurological exam or important cognitive changing. Twelve (57%) presented normal Magnetic Resonance Imaging exams and the alterations found in the others were Wernicke atrophy (1), cistic tumor of the third ventricle (1), double cortex bilateral (1), encephalomalacia (1), cortical diffuse atrophy (1), polimicrogiria (2), frontal displasia (1) and cerebelar atrophy (1). In the electroencephalogram most of the patients (18) showed epileptic discharges, or generalized or multifocal. Three patients had normal EEG. There was an important decrease on the drop attacks numbers. The initial average of crisis in fall in the group was 85 a month and the final average, 13 a month, with a p<0,001 (Wilcoxon test). Thirty-three percent of the patients were free of seizures and 52,3% obtained a decrease of more than 50% in the number of drop attacks. Only one patient didn’t show any improvement with the treatment used. We still observed a good control in other types of epileptic seizures associated to the drop attacks. Conclusions: We saw, with this previous evaluation in a reduced number of patients, that the association of valproate, lamotrigine and a benzodiazepine can be affective in the control of seizures in fall in patients with generalized epilepsy. Literature presents few papers about the drop attacks treatment, and none uses the association of these three drugs. We hope, in the end of the study, to show an effectiveness degree in the control of drop attacks with the association of these three antiepileptics drugs.