Etiology as a risk factor for medically refractory epilepsy
1998; Lippincott Williams & Wilkins; Volume: 51; Issue: 5 Linguagem: Inglês
10.1212/wnl.51.5.1243
ISSN1526-632X
Autores Tópico(s)Neurological disorders and treatments
ResumoEpilepsy is a common, treatable neurologic disorder; however, 20 to 30% of patients with epilepsy have seizures that cannot be completely controlled by antiepileptic drugs.1 As many as half of these patients are potential candidates for surgical treatment.2 A recent advance in surgical treatment for epilepsy is the recognition that among these medically refractory patients are identifiable subgroups who have surgically remediable syndromes.3 These syndromes have a well-defined pathophysiology and natural history, can be identified by noninvasive diagnostic evaluation, and are resistant to pharmacotherapy, but have a high surgical cure rate. Because seizures and their behavioral consequences are progressive, early surgical intervention may prevent irreversible disability. The prototypic surgically remediable syndrome is mesial temporal lobe epilepsy (MTLE), the form of TLE associated with hippocampal sclerosis.4 With modern techniques, 80 to 90% of patients with MTLE become seizure free after anteromesial temporal lobectomy.3,4 Traditional arguments that antiepileptic drugs are usually ineffective, that the condition becomes worse over time, and that surgical treatment is underused because MTLE is a common disorder and surgery is performed relatively rarely are based predominantly on anecdotal evidence derived from patients referred for epilepsy surgery. In this issue, Semah et al.5 provide important new data on the prevalence and prognosis of specific epileptic disorders, including MTLE, encountered over a …
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