Evaluation of Clinical Parameters of Patients with MRI Hippocampal Atrophy with Differential Seizure Control
Abstract number :
1.194
Submission category :
Year :
2001
Submission ID :
2832
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
L.P.A. Andrade-Valenca, MD; M.M. Valenca, MD, Ph.D.; T.R. Velasco, MD; D. Araujo, Jr., MD; V.C. Terra-Bustamante, MD; J.A. Assirati, MD; C.G. Carlotti, Jr., MD, Ph.D.; J.P. Leite, MD, Ph.D., Neurology, Univ. Sao Paulo Sch. Medicine at Ribeirao Preto, Ribe
RATIONALE: Hippocampal atrophy and signal changes, detected at MRI imaging, has been associated to intractable seizures. Such relationship has been usually established by tertiary centers devoted to epilepsy surgery. Therefore, a bias may play a role in sampling more severe epilepsy cases. In addition, increasing case reports have described hippocampal atrophy in patients with good seizure control. In the outpatient clinic of our institution we take care of mesial temporal lobe epilepsy patients (MTLE) with good seizure control and patients with intractable seizures. In the present study we evaluate, in patients with MTLE and hippocampal atrophy at MRI, the clinical variables that may have a relevance on seizure control.
METHODS: MTLE patients from general and intractable out-patient clinics were evaluated at our MRI center with protocols for the temporal lobe. Seizure frequency was estimated retrospectively over a mean period of 7.9 years and quantified over the year 2000. Patients were considered with good control (GC) if they had less than one seizure every three months independently of the antiepileptic therapeutic regime, over . Patients with one or more seizures/months were considered with poor control (PC). Thirty three patients with good-control and 79 patients with refractory epilepsy were analyzed. Dependent variables included presence of an initial precipitating injury (IPI), latent interval, age of first usual epilepsy seizure (FES), epilepsy duration and family history of epilepsy.
RESULTS: Eighteen out of 33 patients (54%) of the good control group did not have a single seizure during the year 2000. Five patients out of 33 (15%) had 3 complex partial seizures over the year 2000. The remaining 10 patients presented 2 or less seizures over the same year. A history of an IPI was found in 63% and 72% of GC and PC groups, respectively . There was no significant difference on IPI age between groups (mean GC=24 and PC=29.5 months , p=0.37). Febrile seizures (FSs) occurred in 5 out of 33 (15%) in the GC group and only one had prolonged convulsion. Frequency of FSs in the PC group was 25 out 79 (31%) with 12% presenting a prolonged convulsion (p=0.12). Latent intervals did not differ between groups. Patients with PC tend to present the FES earlier than GC group (mean [plusminus] SEM, 11.2[plusminus]0.58 vs. 13.6[plusminus]1.3, p=0.037). Frequency of family history was 57.5% and 55% in GC and PC, respectively. Epilepsy duration on GC and PC groups was 26.3 and 24.3 years respectively.
CONCLUSIONS: The present results indicate that MRI evidence of hippocampal atrophy in patients with good seizure control seems to be more frequent than previously reported. Except for early usual seizure onset in patients with PC, all the remaining clinical parameters do not seem to influence seizure outcome.
Support: CNPq, PRONEX and FAPESP (Proc. 99/11729-2, 00/12376-5); Brazil.