Kuzmanovski Igor, Cvetkovska Emilija, Babunovska Marija, Kiteva Trencevska Gordana, Kuzmanovska Biljana, Boshkovski Bojan, Isjanovska Rozalinda
University Clinic of Neurology, Medical Faculty, Ss. Cyril and Methodius University, Vodnjanska str. 17, MK-1000, Skopje, Macedonia.
University Clinic of Neurology, Medical Faculty, Ss. Cyril and Methodius University, Vodnjanska str. 17, MK-1000, Skopje, Macedonia.
Clin Neurol Neurosurg. 2016 May;144:91-5. doi: 10.1016/j.clineuro.2016.03.018. Epub 2016 Mar 24.
Surveys on mesial temporal lobe epilepsy (MTLE) repeatedly demonstrate that seizures are commonly resistant to antiepileptic drugs (AED), but patients usually came from third-level epilepsy centers, making the medically refractory population larger. The aim of our study is to evaluate patterns of seizure control and prognostic factors of general population of MTLE patients observed in clinical practice.
Sixty five MTLE patients were evaluated for demographic data, family history, febrile convulsions, detailed descriptions of auras and seizures, presence of secondarily generalized seizures, age at seizure onset, duration of epilepsy, epileptiform discharges in EEG, neuroradiological findings and AED schedules with therapeutic response. According to seizure frequency, patients were divided into three groups: (1) seizure-free (SF) patients at the time of evaluation, (2) patients considered as having infrequent seizures (IS) if they presented only auras or up to three dyscognitive (complex partial) seizures per year and (3) patients with higher rate were regarded as having frequent seizures i.e. being drug-resistant (DR). For each clinical parameter, the three groups were compared statistically. In addition, following the patterns of evolution over time, patients were categorized into two groups: continuous pattern, with no period of remission, and intermittent pattern, in which patients had at least one period of remission.
Ten patients (15.4%) were seizure free, 19 (29.2%) had infrequent seizures, while 36 patients (55.4%) had frequent uncontrolled seizures. Ten (52.6%) IS patients and ten (27.7%) DR patients had a intermittent i.e. relapse-remitting pattern with at least one period of two years without seizures. Female patients dominated SF group and the gender difference with other groups reached statistical significance (p=0.02). Comparing the groups, DR group had longer seizure duration than IS group (12.6±10.9years vs. 22.8±10.6years, p=0.006). Number of tried AEDs (p<0.00006) was significantly lower in the seizure-free patients. Other variables are not related to course of the epilepsy.
MTLE is a heterogeneous syndrome, 45% of patients in our series were having either rare auras or seizures or were seizure-free. The factors associated with drug resistance were longer duration of epilepsy, higher number of previously tried AED and male gender.
对内侧颞叶癫痫（MTLE）的调查反复表明，癫痫发作通常对抗癫痫药物（AED）耐药，但患者通常来自三级癫痫中心，这使得药物难治性人群规模更大。我们研究的目的是评估在临床实践中观察到的MTLE患者总体人群的癫痫发作控制模式和预后因素。
对65例MTLE患者进行评估，内容包括人口统计学数据、家族史、热性惊厥、先兆和癫痫发作的详细描述、继发全面性发作的情况、癫痫发作起始年龄、癫痫病程、脑电图中的癫痫样放电、神经影像学检查结果以及AED用药方案及其治疗反应。根据癫痫发作频率，患者被分为三组：（1）评估时无癫痫发作（SF）的患者；（2）每年仅出现先兆或至多三次认知障碍（复杂部分性）发作的患者被视为发作不频繁（IS）；（3）发作频率较高的患者被视为发作频繁，即耐药（DR）。对每个临床参数，对三组进行统计学比较。此外，根据随时间的演变模式，将患者分为两组：持续模式，无缓解期；间歇性模式，患者至少有一个缓解期。
10例患者（15.4%）无癫痫发作，19例（29.2%）发作不频繁，而36例患者（55.4%）有频繁的未控制癫痫发作。10例（52.6%）IS患者和10例（27.7%）DR患者有间歇性发作，即复发-缓解模式，至少有一个两年无癫痫发作期。女性患者在SF组中占主导，与其他组的性别差异具有统计学意义（p=0.02）。比较各组，DR组的癫痫病程比IS组长（12.6±10.9年 vs. 22.8±10.6年，p=0.006）。无癫痫发作患者尝试使用的AED数量显著更低（p<0.00006）。其他变量与癫痫病程无关。
MTLE是一种异质性综合征，在我们的系列研究中，45%的患者有罕见的先兆或癫痫发作，或无癫痫发作。与耐药相关的因素包括癫痫病程更长、既往尝试使用的AED数量更多以及男性性别。
