Novel pharmacotherapy in refractory epilepsy associated with structural brain lesions

Abstract

BACKGROUND: Patients with various structural brain lesions often suffer from seizures. Refractory epilepsy is the most common in brain tumors, vascular malformations, and sequel of cerebral infections, infarcts or trauma. OBJECTIVE: To evaluate the efficacy and safety of new AEDs in patients with medically refractory seizures associated with structural brain lesions. MATERIAL AND METHODS: Twenty-six (26) patients (8 M; 18 F), aged 48.4± 7.6 years, with simple (65%) or complex partial (35%) seizures associated with cerebral tumors (12 p) and non-neoplastic brain lesions (14 p) were included in the study. Diagnosis was based on the criteria of ILAE. Patients were treated with OXC (10 cases), LTG (9 cases), and LEV (7 cases) for at least six months. Efficacy and tolerability were assessed on the basis of changes in seizure frequency and reporting the drugs side effects. Structural neuroimaging, EEG, and clinical follow-up were performed before and after AEDs addition. RESULTS: Eighteen (18) patients (72%) were seizure-free after six to twenty-four months treatment period and 8 (28%) experienced some rare partial seizures but no more generalized attacks. Side effect of mild somnolence was observed in 4 patients treated with LTG during the first 3 weeks of the treatment, of transient dizziness in 3 patients under OXC, and transient fatigue in 2 patients treated with LEV. CONCLUSION: In accordance with our own findings and literature review, we suggest that new AEDs due to their efficacy and good safety profile might be useful for the epilepsy control in patients with medically refractory seizures associated with structural brain lesions.