Abstract
BackgroundFocal 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. This study aimed to evaluate the response to antiepileptic drugs (AED) in patients with lesional epilepsy and to identify the predictors for poor seizure control.MethodsOne hundred and sixty-five patients with lesional epilepsy were included; the clinical diagnosis of epilepsy and seizure classification was 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 6 months.Results75.8% of patients with lesional epilepsy showed poor response to antiepileptic medications. Cerebromalatic lesions related to brain trauma was the most frequently encountered (21.8%). Malformations of cortical development were significantly associated with poor response to AED (p = 0.040). Polytherapy and the combined use of 1st- and 2nd-generation AED were higher in the poor response group. Logistic regression analysis revealed that younger age at seizure onset and abnormal EEG findings was 0.965 times and 2.5 times more associated with poor seizure control, respectively.ConclusionThis study revealed that patients with lesional epilepsy who develop seizures in their early life, who suffer from malformations of cortical development, or who show abnormal EEG findings are more suspected to show poor response to AED.
Highlights
One of the key challenges facing physicians treating patients with epilepsy is to predict the response to the administered antiepileptic drugs (AED) and promptly identify drug-resistant epilepsy
Posttraumatic lesions were the most frequently encountered followed by postinfectious cerebromalatic lesions, while malformations of cortical development were the lesion associated with poor response to antiepileptic medications
This might be explained by the fact that both of these later studies were performed in a primary referral seizure service facility where Magnetic resonance imaging (MRI) was done only when localization-related epilepsy was suspected and both of them included cryptogenic epilepsy patients, while in tertiary epilepsy centers, where this study is conducted, patients are subjected to sophisticated imaging evaluation and higher prevalence of severe cases is expected
Summary
One of the key challenges facing physicians treating patients with epilepsy is to predict the response to the administered antiepileptic drugs (AED) and promptly identify drug-resistant epilepsy. This serves both for patient counseling and for early referral of patients to non-pharmacologic treatments such as epilepsy surgery and/or neurostimulation [1]. Previous studies reported that the cause of focal epilepsy can influence the response to AED. This study aimed to evaluate the response to antiepileptic drugs (AED) in patients with lesional epilepsy and to identify the predictors for poor seizure control
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