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Intractable Epilepsy
Intractable Epilepsy
YUSTIANI DIKOT
SUBBAGIAN EPILEPSI
BAGIAN I.P SYARAF
RSHS/FKUP
DEFINITION
Epilepsy with multiple seizures despite
appropriate treatment.
Patients with uncontrolled seizures within 1 year
after appropriate therapy.
Patients developed intolerable side effects that
interfere with their quality of life, despite
maximally tolerated trials of one or more AEDs.
Patients who continue to exhibit 2 or more
disabling seizures per month for a period of 2
years or more despite supervised trials twice
with monotherapies and once with polytherapy.
Medical intractability :
The degree of disability due to seizures or AED toxicity.
Aversion to AED intake.
Social disability:
Other factors such as employment, marriage and driving
license
Evaluation of intractability
Epidemiology
20-30% epileptic patients continue to have
epileptic seizures regardless of treatment
with all AEDs.
They have chronic epilepsy, medically
unsatisfactory controlled epilepsy or
pharmaco-resistant epilepsy.
Diagnostic error.
Inadequate dosage of antiepileptic drugs.
Inappropriate assessment.
Patients lack of cooperation.
Management
Appropriate counseling with the patient
and family about the diagnosis of epilepsy.
Obtaining detailed information about the ictal
and post ictal behavior, aura, oral alimentary
or gestural automatism, ictal paretic posturing.
ictal dysphasia and postictal neurological
deficit.
Therapeutic options
Surgery:
50-60 % patients with anterior temporal (mesial
temporal sclerosis /MTS) lobectomy become seizure
free.
Timing of operation
Surgery early: Epileptic syndromes with
high probability of medical intractability
and a favorable surgical prognosis.
Increasing evidence for a progressive
nature of some epileptic syndromes or for
a possible complication related to the
nature of lesion.