Prospective study of Intractable Epilepsy Clinical Conundrum

Bhoopathy, R M (2017) Prospective study of Intractable Epilepsy Clinical Conundrum. Doctoral thesis, The Tamilnadu Dr. M.G.R. Medical University, Chennai.

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The present study was carried out prospectively to investigate the prevalence, demographics, clinical characteristics, psychological status, structural abnormalities, EEG and quality of life in patients with intractable epilepsy. From 2850 epilepsy patients who were screened using drug-resistant epilepsy criteria, a cohort of 600 patients with intractable epilepsy was considered for data collection over a period of 3 years. Out of 600 patients who have been prospectively followed up only 506 patients with intractable epilepsy completed all the investigations. All patients with intractable epilepsy underwent detailed case history, neurological examination, CT, MRI and DTI imaging of the brain, EEG, and neurological investigations. Out of 2850 patients (1523 males and 1327 females) seen at our epilepsy clinic, 600 (21.05%) patients had drug-resistant epilepsy. The prevalence of intractable epilepsy is reported in the study population is estimated to be 21.05 % that approximates 1 in 5 patients with epilepsy. In the present study, the prevalence of intractable epilepsy was observed more in males compared to females possibly due to the patient attending the clinics were majorly males compared to females. Analysis on educational and occupational status showed that high proportions of patients with intractable epilepsy were illiterate (16.8%) and large proportion of them discontinued school at elementary level (32.21%) causing high levels of unemployment (37%). Early seizure onset, longer duration of seizure, polytherapy, and low IQ and MQ scores were significantly associated with lower education levels and unemployment in intractable epilepsy. Clinical characteristics of intractable epilepsy patients were often heterogeneous and do correlated with several studies carried out in literature by several authors in Indian and Western literature. It was observed that partial type of seizures, younger age of seizure onset, change in seizure semiology, clustering and polytherapy contribute to intractability. Interictal EEG studies in intractable epilepsy are highly variable and insensitive in providing information regarding the foci of seizure onset. But in 15% of the population it is often sensitive to identify seizure foci in focal cortical dysplasia and MTS. Structural imaging investigations revealed various congenital malformations of cortical development, mesial temporal sclerosis, neoplastic and nonneoplastic lesions, nonspecific lesions and incomplete hippocampal inversion of brain approximately in 94% of population. Interestingly in the series of 506patients, it was observed that significant proportion of patients with intractable epilepsy have calcifications. Diffusion tensor weighted images showed significant white matter structural changes in 80% of patients which signify DTWI as an important tool to trace the epileptogenic network. One third of patients (29.05%) with intractable epilepsy were mentally retarded, and around 40% of them had significant memory impairments and visuoperceptual abnormalities. Cognitive impairments were significantly associated with early age of seizure onset, MTS, polytherapy and chronicity of the disease in the study population. Also anxiety and depression were associated in one third of intractable epilepsy patients who were not mentally retarded. These populations are high risk for suicidal ideation as reported in literature. Quality of life were similarly poor in 40% of the population who were not mentally retarded. Thus the present study highlights that cognitive impairment and psychological co-morbidities are very common in patients with intractable epilepsy which requires necessary action to address these psychological problem by means of psychological counselling to rehabilitate them in a right way. Though intractable epilepsy patients were studied by neuroimaging and electrophysiological (EEG) techniques, they are insensitive in identifying structural abnormalities in 6.18% in whom structural abnormalities are still unknown. High resolution imaging facilities may help to identify structural lesions in these populations. Moreover biochemical and other investigations for metabolic disorders would add an additional value in identifying the cause for intractability in patients without any structural abnormalities. Intractable epilepsy being a heterogeneous group which is difficult to manage, use of modern diagnostic tools may aid in identifying the epileptogenic zone and thereby it may help in surgical intervention for the management of intractable epilepsy. LIMITATIONS OF THE STUDY: Though intractable epilepsy patients were prospectively studied, the various clinical manifestations, structural, electrophysiological and psychological findings in patients with intractable epilepsy, it is often difficult to group them into sub-categories. This study had tried to include most of the investigations to understand intractable epilepsy but still, a few percentage of them remained to be a clinical conundrum. One of the major limitations of the study is not having a control group of the epileptic population to identify the major risk factors in intractability. Though the aim of the present study is not to study the predictors for intractable epilepsy adding a control group might lead us in a better understanding of intractable epilepsy.

Item Type: Thesis (Doctoral)
Uncontrolled Keywords: Prospective study, Intractable Epilepsy, Clinical Conundrum.
Subjects: MEDICAL > Neurology
Depositing User: Subramani R
Date Deposited: 18 Jan 2022 14:43
Last Modified: 18 Jan 2022 14:43

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