| |
ANTI-EPILEPTIC DRUG REGIMEN STATUS BEFORE AND AFTER CORTICO-AMYGADALO-HIPPOCAMPECTOMY
IN PATIENTS WITH UNILATERAL MESIAL TEMPORAL SCLEROSIS.
Baldauf CM, Cukiert A, Burattini JA, Mariani PP, Camara RB, Seda L, Argentoni-Baldochi M, Baise-Zung C, Forster CR, Mello VA.
Department of Neurology and Neurosurgery, Epilepsy Surgery Program, Hospital Brigadeiro and Clinica de Epilepsia de Sao Paulo, Sao Paulo SP, Brazil (acukiert@uol.com.br).
Rationale: The surgical outcome after temporal lobe resections regarding seizure frequency has been extensively reported over the last decades. On the other hand, the status of the anti-epileptic drug (AED) regimen of these patients has been poorly studied, especially over long follow-up periods. We describe the status of the AED regimen in a series of patients with mesial temporal sclerosis submitted to cortico-amygdalo-hippocampectomy.
Methods: Forty one patients with refractory unilateral temporal lobe epilepsy were studied. Mean post-operative follow-up time was 4.3+1.1 years. MRI disclosed unilateral mesial temporal sclerosis (MTS) in all patients. All patients had interictal EEG recordings. All patients were submitted to cortico-amygdalo-hippocampectomy at the side determined by MRI. The AED regimen status was recorded before and at the last follow-up visit.
Results: Thirty-nine patients (95, 1%) were classified as Engel’s Class I (70,6% Engel I-A) and two (4.9%) as Engel's Class II, postoperatively. Eleven patients (26.8%) were not taking any AED. The pre- and post-operative AED regimen status could be summarized as follows:
AED |
Before Surgery |
After Surgery |
|
N |
Daily Dose Mean (mg) |
N |
Daily Dose Mean (mg) |
Carbamazepine |
27 |
1.059,3 |
23 |
608,7 |
Fenobarbital |
22 |
113,6 |
14 |
96,4 |
Phenytoin |
10 |
280,0 |
4 |
200,0 |
Oxcarbazepine |
8 |
900,0 |
0 |
- |
Valproic Acid |
3 |
733,3 |
1 |
1.000,0 |
Clonazepam |
3 |
2,0 |
1 |
4,0 |
Lamotrigine |
2 |
125,0 |
0 |
- |
Clobazam |
1 |
20 |
3 |
20 |
Topiramate |
1 |
150 |
0 |
- |
Gabapentine |
1 |
1.200 |
0 |
- |
Discussion: One quarter of the patients were taking no AED at late follow-up. The majority of the others were taking much lower dosages of AED. Valproic acid was the only AED more extensively used post-operatively in this series; it is currently used in the treatment of post-operative hypomania seen in some of these patients.
|
