Abstracts

Rationale: Post-surgical residual or relapsing seizures (PSRSz) are thought to be very refractory to medical therapy. Is it true? We have presented the efficacy of pharmacotherapy for chronic non-idiopathic partial epilepsies based on the precise seizure (Sz) symptoms by retrospective study (2009, 28th International Congress of Epilepsy) and confirmed it by prospective study (2010, 64th AES). We treated PSRSz based on the precise Sz symptoms to develop rational pharmacotherapy for PSRSz.Methods: 42 surgical cases including 32 cases of residual Sz and 10 cases of relapsing Sz, treated with antiepileptic drugs (AEDs) for >1 year (1.8-20 years) by the author, were recruited. They underwent epilepsy surgery (hemisperectomy, 7 cases, lesionectomy, 15 cases, callosotomy, 20 cases) at 3 months-20 years of age. Their epileptic syndromes consisted of Ohtahara syndrome 5 cases, Lennox-Gastaut syndrome 10 cases, symptomatic generalized epilepsies 8 cases, partial epilepsies 19 cases (FLE 14, TLE 2, OLE 3). Their underlying diseases included hemimegalencephaly 4 cases, FCD 15cases, ulegyria 1, encephalitis 3, massive hemorrhage 1, hamartoma 1, non-lesional 17(symptomatic West syndrome 7, no notable causes 10). AEDs were chosen based on the precise Sz symptoms of PSRSz and increased, added or switched. AEDs with responder rate >50% for each Sz symptoms were applied for partial Sz: ZNS, PB, KBr, LTG, CLZ for tonic Sz, ZNS, PB, PHT for secondarily generalized Sz (sGTCS), CBZ, PHT, CLB for clonic Sz, PHT, CBZ for hypermotor Sz, ZNS, PB, KBr, CBZ for negative motor area Sz, CLZ, CLB CBZ for motion arrest/impaired consciousness, and CBZ, CLB for sensory/autonomic Sz. AEDs for generalized Sz symptoms were selected based on NICE Clinical practice guideline (2004). Baseline PSRSz and outcome of pharmacotherapy were evaluated by Engel s classification compared to the presurgical Sz frequency.Results: There were single Sz type in 14 cases, two Sz types in 25 cases and three Sz types in 3 cases. Tonic Sz was seen in 32 cases, sGTCS in 11, clonic Sz in 4, hypermotor Sz in 2, negative motor area Sz in 4, motion arrest/impaired consciousness in 8, sensory/autonomic Sz in 2, tonic spasm in 3, myoclonic Sz in one, and gelastic Sz in one. PSRSz included class III in 11cases and class IV in 31 cases. Among 11 cases with class III PSRSz, class I was obtained in 8 cases and class II in 3 cases by pharmacotherapy. For 31 cases with class IV PSRSz, class I was obtained in 12 cases, class II in 1 case, class III in 14 cases, and class IV in 4 cases by pharmacotherapy.. 57% of class III and IV PSRSz resulted in class I and II by pharmacotherapy. The most effective AEDs for each case were ZNS in 11 cases, LTG in 6, KBr in 5, CLB in 4, CBZ in 4, CLZ in 3, PB in 2, PHT in 2, TPM and ACTH in one each.Conclusions: PSRSz can be controlled or reduced by rational pharmacotherapy based on the precise Sz symptoms. This seems to be yielded by reduction of epileptogenic zone or transmission of epileptic activity by surgery, which results in decrease of epileptogenicity.