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

• Autorzy: Alexandra Rohracher , Judith Dobesberger , Claudia A. Granbichler , Julia Höfler , Giorgi Kuchukhidze , Martin Ortler , Iris Unterberger , Gerald Walser , Aljoscha Thomschewski , Eugen Trinka
• Języki publikacji: EN

Abstrakty

EN

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.

Słowa kluczowe

EN

definitions of drug resistant epilepsy; epilepsy surgery

• Czasopismo: Journal of Epileptology
• Rocznik: 2015
• Tom: 23
• Numer: 1
• Strony: 39-44

Daty

wydano

2015-06-01

otrzymano

2015-01-25

zaakceptowano

2015-03-19

online

2015-05-16

Twórcy

autor

Alexandra Rohracher

• Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria
• Department of Neurology, Medical University Innsbruck, Innsbruck, Austria

autor

Judith Dobesberger

• Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria
• Department of Neurology, Medical University Innsbruck, Innsbruck, Austria

autor

Claudia A. Granbichler

• Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria
• Department of Neurology, Medical University Innsbruck, Innsbruck, Austria

autor

Julia Höfler

• Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria
• Department of Neurology, Medical University Innsbruck, Innsbruck, Austria

autor

Giorgi Kuchukhidze

• Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria
• Department of Neurology, Medical University Innsbruck, Innsbruck, Austria

autor

Martin Ortler

• Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria

autor

Iris Unterberger

• Department of Neurology, Medical University Innsbruck, Innsbruck, Austria

autor

Gerald Walser

• Department of Neurology, Medical University Innsbruck, Innsbruck, Austria

autor

Aljoscha Thomschewski

• Centre for Cognitive Neuroscience, Salzburg, Austria

autor

Eugen Trinka

• Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria,
• Department of Neurology, Medical University Innsbruck, Innsbruck, Austria

Bibliografia

• Berg A.T., Shinnar S., Levy S.R., Testa F.M., Smith-Rapaport S., Beckerman B.:Early development of intractable epilepsy in children: a prospective study. Neurology, 2001, 56: 1445–1452.
• Berg A.T., Vickrey B.G., Langfitt J.T., Sperling M.R., Walczak T.S., Shinnar S. et al.:The Multicenter Epilepsy Surgery Study: recruitment and selection for surgery. Epilepsia, 2003, 44: 1425–1433.
• Berg A.T., Kelly M.:Defining Intractability: Comparison among published definitions. Epilepsia, 2006, 47: 431–436.
• Callaghan B.C., Anand K., Hesdorffer D., Hauser W.A., French J.A.:Likelihood of seizure remission in an adult population with refractory epilepsy. Ann. Neurol., 2007, 62: 382–389.[WoS]
• Camfield P., Camfield C.:Nova Scotia pediatric epilepsy study. In: P. Jallon, A. Berg, O. Dulac, A. Hauser (Eds.), Prognosis of Epilepsies. John Libbey, Eurotext, Montrouge 2003, 113–126.
• Engel J.Jr., Wiebe S., French J., Sperling M., Williamson P., Spencer D. et al.:Practice parameter: Temporal lobe and localized neocortical resections for epilepsy. Neurology, 2003, 60: 538–547.
• Engel J.Jr., McDermott M.P., Wiebe S., Langfitt J.T., Stern J.M., Dewar S. et al.:Early Randomized Surgical Epilepsy Trial (ERSET) Study Group. Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial. JAMA, 2012, 307: 922–930.
• José F., Téllez-Zenteno J.F., Dhar R., Wiebe S.:Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis. Brain, 2005, 128: 1188–1198.
• Kwan P., Arzimanoglou A., Berg A.T., Brodie M.J., Allen Hauser W., Methern G. et al.:Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia, 2010, 51: 1069–1077.[WoS]
• Langfitt J.T., Wiebe S.:Early surgical treatment for epilepsy. Curr. Opin. Neurol., 2008, 21: 179–183.[WoS]
• Liimatainen S.P., Raitanen J.A., Ylinen A.M., Peltola M.A., Peltola J.T.:The benefit of active drug trials is dependent on aetiology in refractory focal epilepsy. J. Neurol. Neurosurg. Psychiatry, 2008, 79: 808–812.[WoS]
• Mohanraj R., Brodie M.J.:Diagnosing refractory epilepsy: response to sequential treatment schedules. Eur. J. Neurol., 2006, 13: 277–282.
• Neligan A., Bell G.S., Elsayed M., Sander J.W., Shorvon S.D.:Treatment changes in a cohort of people with apparently drug-resistant epilepsy: an extended follow-up. J. Neurol. Neurosurg. Psychiatry, 2012, 83: 810–813.[WoS]
• Sperling M.R., O’Connor M.J., Saykin A.J., Plummer C.:Temporal lobectomy for refractory epilepsy. JAMA, 1996, 276: 470–475.
• Trinka E., Martin F., Luef G., Unterberger I., Bauer G.:Chronic epilepsy with complex partial seizures is not always medically intractable. Acta Neurol. Scand., 2001, 103: 219–225.
• Wiebe S., Blume W.T., Girvin J.P., Eliasziw M.:Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study Group. A randomized, controlled trial of surgery for temporallobe epilepsy. NEJM, 2001, 345: 311–318.

Identyfikatory

DOI

10.1515/joepi-2015-0025