Assessment of the response to antiepileptic drugs in epileptic patients WITH structural lesion(S) on neuroimaging

Abstract

Focal epilepsy is the most common form of epilepsy in adults. Advances in brain imaging allowed better identification of different structural lesions underlying focal epilepsy. However, the response to antiepileptic drugs in lesional epilepsy is heterogeneous and difficult to anticipate. To evaluate the response to antiepileptics in patients with lesional epilepsy and to identify the predictors for poor seizure control. This study included 165 patients with lesional epilepsy, the clinical diagnosis of epilepsy and seizure classification were based on the revised criteria of the International League Against Epilepsy (ILAE). Patients were subjected to full clinical assessment, MRI brain imaging epilepsy protocol and EEG monitoring. All subjects were followed in the epilepsy clinic for at least six-month, epilepsy was defined as “well controlled” if the patient reported less than one seizure per month. 75.8 % of patients with lesional epilepsy showed poor response to antiepileptic medications. Cerebromalatic lesions related to brain trauma were the most frequently encountered (21.8%). Malformations of cortical development were significantly associated with poor seizure control (p=0.040). Logistic regression analysis revealed that younger age at seizure onset and abnormal EEG findings were 0.965 times and 2.5 times more associated with poor seizure control respectively. This study revealed that high percent of epilepsy patients with MRI brain lesions suffer from poor seizure control. Patients with early onset epilepsy, malformations of cortical development and abnormal EEG findings should be closely monitored and evaluated for uncontrolled seizures