Predictive factors for intractable epilepsy

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(a) drug control rate of epilepsyThe 1 type of attack and drug control rate (sillanpaa, 1993) absence seizures is close to 100%; tonic cloni

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(a) drug control rate of epilepsy

The 1 type of attack and drug control rate (sillanpaa, 1993) absence seizures is close to 100%; tonic clonic seizures (GTCS) 59%-98%; partial motor seizures 54%; complex partial seizures (CPS) 42%; West 40%-50% syndrome; Lennox-Gastaut syndrome 20%-40%; mixed seizures 33%. If the drug control rate of epilepsy was set at 60% as a good response to AEDs treatment, the latter 5 types may develop intractable epilepsy.

2 epilepsy and drug control rate of origin (Semah, 1998) of temporal lobe epilepsy (20% temporal lobe epilepsy of temporal lobe epilepsy without HS was 31%, HS was 10%, with the change of temporal lobe epilepsy in other parts of dual pathology such as HS, brain malformation or multi lobar lesions only 3%); parietal lobe epilepsy 33%; 35% occipital lobe epilepsy, frontal lobe epilepsy 37%. Thus, temporal lobe epilepsy is the most common intractable epilepsy, HS is the main determinant of refractory.

The reason that the abnormal brain structure and drug control rate of epilepsy after stroke 54% 3 Neuroimaging; 50% vascular malformation; 46% tumors; head trauma 30%; cortical dysplasia 24%; HS 11%; 3% MRI 42% normal overlap lesions. Another parallel study showed that partial seizures in patients with epilepsy drug control rate in HS was 42%, cortical dysplasia was 54%, cortical atrophy 55%, cortical gliosis in 57% primary tumors was 60%, 67% MRI 58% normal cerebral infarction.

(two) the risk factors of intractable epilepsy

Partial seizures indicate "refractory" risk factors are: acquired brain injury; nerve function defect; the spirit of development slow; the early age of onset; the type of attack, or with multiple seizure types: West syndrome, Lennox-Gastaut syndrome and complex partial seizures with tonic clonic seizures; the high attack frequency, long duration of the disease, a history of the status epilepticus; EEG graphic generalization of epileptic activity. Multivariate regression analysis of prognostic factors in patients with partial epilepsy was also performed by Semah. Kwan believes that some patients with epilepsy from the beginning of intractable epilepsy, and not with the course of evolution, because these patients early in the course of the disease has showed some "refractory" clinical features, such as basic structural brain abnormalities before treatment, there have been 20 times more than first kinds of attacks, AED is invalid. A high degree of drug resistance epilepsy often suggests HS or brain development abnormalities, these patients switch to second kinds of AED after the 14% effective, the combination of the two drugs is only effective in the work of 3%. Perhaps because of the difference in the expression of drug transporters in the blood-brain barrier, AED enters the epileptogenic focus is limited, it is difficult to achieve the desired effect before the neurotoxicity concentration.

Rantala (1999) on infantile spasms (West syndrome) and Lennox-Gastaut syndrome (LGS) prognosis was also studied. Data show that in infantile spasms, the evolution of LGS 23%-54%; and LGS, 20%-36% has a history of infantile spasms. Both the infantile spasms and LGS patients have basic brain diseases, poor prognosis; and cryptogenic infantile spasms in 1 cases developed LGS, the prognosis is good. 87% the symptoms of infantile spasms and symptomatic LGS all have syndrome caused by congenital or genetic defects of brain malformations, encephalopathy, chromosomal abnormalities and different, so that the prognosis of infantile spasms and depends on the relationship between LGS in the etiology of infantile spasms and brain lesions (such as progressive encephalopathy, encephalopathy with EEG and edema of hypsarrhythmia and optic nerve atrophy, brain malformations, chromosomal abnormalities, tuberous sclerosis, neonatal asphyxia and intraventricular hemorrhage, puppet syndrome) instead of epilepsy itself.

 

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