Мезијална темпорална епилепсија: клинички фенотипи и прогностички фактори

Abstract

Introduction: Mesial temporal lobular epilepsy (MTLE) is the most common type of focal epilepsy in adults. Although great progress has been made in understanding epilepsy from the temporal lobe, there are still many dilemmas, particularly about the interaction and interaction of genetic factors, febrile convulsions, hippocampal sclerosis, clinical variables, and MTLE. The available field studies are mainly from highly specialized surgical centers and, therefore, there is probably a bias towards the forecast in the direction of refractivity. Because of this, the existence of clinical phenotypes (forms) with benign evolution and a good prognosis is probably underrecognized. Aim: To define the different phenotypes of MTLE and evaluate the clinical, neuro-radiological and genetic prognostic factors of MTLE. Material and methods: In the prospective study, 65 examinees were defined, defined as a sample of patients with temporal epilepsy of both sexes who are on medication therapy. The long-term seizure assessment for each patient was made for the entire period since the onset of the seizures. According to the frequency of seizures, patients were divided into three groups. The first group consists of patients who were seizure free at the time of evaluation, i.e in remission. The second group consists of patients with rare seizures. There were patients who had only aura or up to three focal seizures a year and no generalized tonic-clonic seizure. All patients with a higher number of seizures make up the third group ie patients with frequent seizures, that is, patients with medically refractory femoral epilepsy. For each examined parameter, a comparison was made between the three groups of patients in order to detect the parameters that influence the prognosis of epilepsy. The demographic data, clinical data on the disease, EEG findings (routine, sleep or long-term video-EEG monitoring) were analyzed, MRI for detecting the existence of hypocampal sclerosis and genetic testing for the detection of polymorphisms of the SCN 1A gene. The data were analyzed using appropriate descriptive and analytical statistical methods. Results: Ten patients (15.4%) were seizure free, 19 (29.2%) had infrequent seizures, while 36 patients (55.4%) had frequent uncontrolled seizures. Ten (52.6%) IS patients and ten (27.7%) DR patients had aintermittent i.e. relapse-remitting pattern with at least one period of two years without seizures. Femalepatients dominated SF group and the gender difference with other groups reached statistical significance (p = 0.02). Comparing the groups, DR group had longer seizure duration than IS group (12.6 ± 10.9 years vs.22.8 ± 10.6 years, p = 0.006). Number of tried AEDs (p < 0.00006) was significantly lower in the seizure-freepatients. Other variables are not related to course of the epilepsy. Conclusion: MTLE is a heterogeneous syndrome, 45% of patients in our series were having either rareauras or seizures or were seizure-free. The factors associated with drug resistance were longer durationof epilepsy, higher number of previously tried AED and male gender.