Evaluation of drug-resistant focal epilepsy in the western Indian adult population

Despite the best possible pharmacotherapy, 30% of persons with epilepsy will remain drug resistant. Drug resistant Epilepsy (DRE) has many different presentations and causes; hence evaluation may help to understand and manage appropriately. To study a cohort of adult patients with refractory focal epilepsy, focusing on clinical semiology, risk factors, imaging and video EEG findings. This is a prospective observational study done in adult neurology department of tertiary care hospital, from 2013 to 2016. The primary inclusion criteria were patients with drug refractory focal seizure (as per ILAE definition 2010), with age more than 12 years. Detailed clinical data, long term EEG monitoring, MRI and minimum follow up of 6 months were collected. Of 120 patients of DRE, 72% were in the age group of 12-30 yrs. Febrile seizure (26%) and head injury (17%) were the most significant antecedent history. Focal seizures with dyscognitive features were present in 87%. 16 patients had abnormal neurological examination. The most common radiological finding was mesial temporal sclerosis and gliosis. After complete evaluations, 30% of the patients were found to have pseudo-resistance. The evaluation led to modification of treatment in more than three-fourth of the patients. Early age of onset, history of febrile seizures, past history of head injury, focal dyscognitive type of seizures and structural lesion on imaging are common factors in patients with DRE. Pseudo- resistance due to wrong diagnosis and inadequate AEDs were responsible for one third of cases.

尽管采用了最佳的药物治疗，30%的癫痫患者仍会对药物产生耐药性。耐药性癫痫（DRE）有许多不同的表现和病因；因此，评估可能有助于正确理解和处理。对一组成年难治性局灶性癫痫患者进行研究，重点关注临床症状学、危险因素、影像学以及视频脑电图检查结果。这是一项在一家三级医院成人神经科进行的前瞻性观察研究，时间从2013年到2016年。主要纳入标准为符合2010年国际抗癫痫联盟定义的药物难治性局灶性发作患者，年龄大于12岁。收集了详细的临床资料、长期脑电图监测结果、磁共振成像资料以及至少6个月的随访情况。在120例耐药性癫痫患者中，72%的患者年龄在12 - 30岁之间。热性惊厥（26%）和头部外伤（17%）是最重要的既往病史。87%的患者存在伴有认知障碍特征的局灶性发作。16例患者神经系统检查异常。最常见的影像学发现是内侧颞叶硬化和胶质增生。经过全面评估，30%的患者被发现存在假性耐药。评估使超过四分之三的患者治疗方案得到调整。发病年龄早、热性惊厥病史、头部外伤既往史、局灶性认知障碍型发作以及影像学上的结构性病变是耐药性癫痫患者的常见因素。因误诊和抗癫痫药物使用不当导致的假性耐药占病例的三分之一。