[Refractory epilepsies].

Abstract

STUDY OBJECTIVE: To describe the role of multidisciplinary evaluation and general aspects of intractable epilepsies such as age at the onset, etiologic factors, CT scan findings, electroencephalographic abnormalities, types of epileptic seizures, adherence, and crisis-triggering factors. TYPE OF STUDY: Retrospective. SITE: Department of Epilepsy Research and Treatment (SITE)--São Paulo, Brazil. PATIENTS: Analysis encompassed 80 epileptic patients registered with the SITE, who had one or more crises per week, with a minimum follow-up of one year, older than 13 and seen between August and October 1989. INVESTIGATIONS: psychologic, social, nursing, and neurologic evaluations. Treatment performed with antiepileptic drugs. MEASUREMENTS AND RESULTS: Mean age at onset of epilepsy = 12.6 years; 70% of patients have symptomatic partial epilepsy; 66.2% had epilepsy onset after 5 years of age; 80% have had epilepsy for more than 10 years; etiology was not determined in 47.5% of the cases and, in 22.5%, it was due to neurocysticercosis; 88.7% of the patients were having anti-epileptic polytherapy; 50% of the patients did not adhere to the treatment; 56.25% reported emotional originating factors; 60% were socially non-adjusted; 30% had abnormal EEG in the right temporal lobe; 26.2% in the left temporal lobe; 21.2% had normal EEG plotting, and the remainder had their EEG with focal abnormalities in other locations. CONCLUSIONS: The authors accept the fact that a patient who does not lead a balanced social, affective, and emotional life should be classified as a probable case of intractable epilepsy. The authors observed that a large portion of the patients could be seen as pseudodifficult treatment cases, since 50% were non-adherent to treatment, and 56.25% reported the presence of emotional originating factors. As most of these patients have social and psychological maladjustments, perhaps due to their high incidence of epileptic crises, they may be cases of intractable epilepsies.