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The ILAE definition of drug resistant epilepsy and its clinical applicability compared with “older” established definitions

100%

Rohracher A., Dobesberger J., Granbichler C. A., Höfler J., Kuchukhidze G., Ortler M., Unterberger I., Walser G., Thomschewski A., Trinka E.

Journal of Epileptology

2015

vol. 23

issue 1

39-44

Background. Early identification of potential epilepsy surgery candidates is essential to the treatment process. Aim. To evaluate the clinical applicability of the ILAE definition of drug resistant epilepsy and its potential in identifying surgical candidates earlier compared to three established “older” definitions of drug resistant epilepsy. Material and Methods. Retrospective analysis of 174 patients who underwent epilepsy surgery between 1998 and 2009. Clinical factors and course of disease were extracted from patients' charts. Drug resistant epilepsy was classified according to four definitions and the time until fulfillment of criteria compared. Results. Mean time to fulfillment of criteria of drug resistant epilepsy ranged from 11.8 (standard deviation (SD) 9.8) to 15.6 years (SD 11.3). Time to drug resistance was significantly longer applying the only definition, requiring failure of three antiepileptic drugs (AEDs) (Canada definition), whereas time to fulfillment of all other definitions did not differ. Fifty percent of all patients experienced a seizure free period of ≥1 year prior to being classified as drug resistant, 13% entered another 1-year remission after fulfilling any criteria for drug resistance. Conclusion. We conclude that the ILAE definition identifies drug resistant epilepsy, with similar latency like two of three formerly used definitions. It is an easy applicable tool to minimize the delay of referral to a specialized center. Intermittent remissions delay assessment of drug resistance for all definitions and 13% of patients enter a remission despite established drug resistance.

The lateralizing and localizing value of peri-ictal cough in epileptic seizures

70%

Korkmaz B., Erşen G., Delil Ş., Özkara Ç., Yeni S. N.

vol. 21

issue 2

71-77

Introduction. Coughing may be observed as an epiphenomenon during or after epileptic seizures. Aim. In this paper we discuss the lateralization and localization value of cough as an epileptic peri/post ictal semiological phenomenon. Material and Methods. Seven patients presenting cough as a part of their symptomatology are presented. We will discuss cough in the context of these seven patients. Results. Six out of these seven patients were multidrug resistant temporal lobe epilepsy patients, all were right handed. They were all examined for possible epilepsy surgery and four underwent surgery with complete seizure freedom. We do not have certain evidence for lateralization in one patient with hot water epilepsy though déjà vu as an initial symptom in this patient implies a temporal lobe onset. The seven other patients had temporal lobe epilepsy. Among the patients who had surgery, three had left sided and one had right sided temporal lobe surgery with consequent seizure freedom. Conclusion. Referring to the argument in the literature, with our small patient sample, we might conclude that cough has significant value in localizing seizures to the temporal lobe but overall these limited data do not suggest a lateralizing value.

Chirurgiczne metody leczenia padaczki

41%

Kaczorowska B., Pawełczyk M., Przybyła M.

Aktualności Neurologiczne

2012

vol. 12

issue 3

159-163

Despite a systematic and multidrug treatment, about 6–10% epileptic patients continue to present epileptic seizures. This is the so-called drug-resistant epilepsy. Authors discuss currently available surgical epilepsy treatment. Potential candidates are patients with focal epilepsy and epileptogenic foci which may be removed without causing new neurological deficits. We present diagnostic techniques enabling precise location of focus within the brain (Holter EEG, videometry, telemetry, digital EEG, MRI, SPECT, PET, electrocorticography). We also show the types of neurosurgical procedures used in epilepsy therapy: procedures of resection (lobectomy, lesionectomy, hemispherectomy, extensive multilobar resection), procedures of disconnection (callosotomy) and procedures of neurostimulation (vagus nerve stimulation, deep brain stimulation). We consider these methods might be of benefit in a selected group of patients with drug-resistant epilepsy.

U około 6–10% chorych z padaczką, u których stosowano różne kombinacje leków przeciwpadaczkowych, mimo systematycznego leczenia nadal występują napady. Są to chorzy z tzw. padaczką lekooporną. Autorzy przedstawiają możliwości chirurgicznego leczenia takich osób. Potencjalnymi kandydatami do takiego leczenia padaczki są też chorzy z napadami częściowymi prostymi z precyzyjnie określonym ogniskiem padaczkorodnym, którego usunięcie jest możliwe i nie spowoduje powstania u pacjenta tzw. ubytków neurologicznych. W pracy omówiono techniki diagnostyczne pozwalające zlokalizować ognisko padaczkowe w mózgu (EEG z możliwościami długotrwałego monitorowania: Holter, wideometria, telemetria; cyfrowe EEG: rezonans magnetyczny, SPECT, PET, elektrokortykografia). Przedstawiono także rodzaje zabiegów neurochirurgicznych wykonywanych w celu leczenia padaczki: zabiegi resekcyjne (lobektomia, lezjonektomia, hemisferektomia, rozległa resekcja wielopłatowa), zabiegi rozłączeniowe (kallozotomia) oraz zabiegi neurostymulacyjne (stymulacja nerwu błędnego, głęboka stymulacja mózgu). Autorzy uważają, że w pewnych określonych przypadkach chorych z padaczką niepoddającą się leczeniu farmakologicznemu są to skuteczne metody leczenia.

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2 Journal of Epileptology

1 Aktualności Neurologiczne

1 2015

1 2013

1 2012

1 Delil Ş.

1 Dobesberger J.

1 Erşen G.

1 Granbichler C. A.

1 Höfler J.

1 Kaczorowska B.

1 Korkmaz B.

1 Kuchukhidze G.

1 Ortler M.

1 Pawełczyk M.

1 Przybyła M.

1 Rohracher A.

1 Thomschewski A.

1 Trinka E.

1 Unterberger I.

1 Walser G.

1 Yeni S. N.

1 Özkara Ç.

Search results

The ILAE definition of drug resistant epilepsy and its clinical applicability compared with “older” established definitions

The lateralizing and localizing value of peri-ictal cough in epileptic seizures

Chirurgiczne metody leczenia padaczki