Pharmacoresistant epilepsy: If at first you don't succeed...

University of California, San Francisco, San Francisco, California, United States
Annals of Neurology (Impact Factor: 9.98). 10/2007; 62(4):311-3. DOI: 10.1002/ana.21274
Source: PubMed
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    ABSTRACT: More than half of patients with newly diagnosed epilepsy achieve complete seizure control without major side-effects. Patients who continue to have seizures after initial medical therapy should have an early and detailed assessment to confirm the diagnosis, to determine the underlying cause and epilepsy syndrome, and to choose an adequate treatment strategy. The risks and potential benefits of surgical procedures or experimental therapy have to be weighed against the chance of improvement and the potential side-effects of additional medical therapy. Surgery for temporal lobe epilepsy, the most common cause of focal epilepsy, can control seizures and improve quality of life in appropriately selected patients. However, around 20-30% of patients do not respond to medical or surgical treatment. The management of chronic intractable epilepsy requires comprehensive care to address the adverse events of medical treatment, quality of life issues, and comorbid disorders. Much research focuses on the experimental treatment options that offer hope of seizure reduction or cure.
    No preview · Article · Jul 2008 · The Lancet Neurology
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    ABSTRACT: Until recently, very little data existed on long-term seizure prognosis of patients with intractable epilepsy. We review recent work that assessed seizure remission in patients with intractable epilepsy during medical management. Recent prevalence cohort studies among adults with longstanding intractable epilepsy have demonstrated notable proportions of patients attaining at least 1-year seizure freedom, ranging from more than 10% to nearly 30% of patients, when followed for mean duration of 18 months to 6 years. Additionally, a recent prospective cohort study of pediatric-onset intractable epilepsy (followed prospectively for seizure outcome from onset of intractability) revealed minimum 1-year seizure remission among more than half of study patients. Despite the notable rates of remission seen among patients with intractable epilepsy, many individuals experienced subsequent seizure relapse. These findings highlight the continued importance of surgical therapy for those who are good candidates and the need for further development of effective therapeutic interventions.
    No preview · Article · Apr 2011 · Current Neurology and Neuroscience Reports
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    ABSTRACT: The aim of this retrospective study is to describe changes of seizure frequency in epilepsy patients who participated in the Andrews/Reiter behavioral intervention for epilepsy. For this uncontrolled retrospective study, data were extracted from patients' medical journals. Intention-to-treat-analyses were restricted to patients with sufficient documentation supporting a diagnosis of probable or definite epilepsy. Main outcome variable was a comparison of mean seizure frequency at baseline and toward completion of the program. The seizure frequency of 30 (50%) patients showed a clinically meaningful improvement (>50% reduction of seizures) toward the end of the intervention. Twenty-two (37%) patients became seizure-free at the end of the intervention. In summary, a clinically meaningful reduction in reported seizure frequency was observed in epilepsy patients who received the Andrews/Reiter intervention for epilepsy. Prospective trials are needed to further investigate the program's efficacy and to study epileptic seizure triggers.
    Full-text · Article · Feb 2012 · Epilepsy & Behavior