Identification of pediatric patients with pharmacoresistant epilepsy and selection of candidates of non-pharmacological therapy

Česká verzia

Authors: P. Hanáková; O. Horák; M. Ryzí; H. Ošlejšková
Authors place of work: Klinika dětské neurologie LF MU a FN Brno, Centrum pro epileptologii a epileptochirurgii LF MU, Brno
Published in the journal: Cesk Slov Neurol N 2018; 81(2): 180-184
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2018180

Summary

Aim:
The aim of the study was to perform an audit of pediatric patients with pharmacoresistant epilepsy who were observed on a long-term basis at our department and to select candidates who are potentially eligible for non-pharmacological therapy (epileptosurgery, ketogenic diet or its modification).

Methods:
This is a retrospective study evaluating medical records of 129 patients (aged 0–19 years) with refractory epilepsy examined at the Department of Pediatric Neurology from January 2014 to January 2015. Based on the type of seizures, epilepsy, etiology, MRI and brain PET findings, physicians recommended an educational interview concerning non-medication therapy or indicated that anti-epileptic drugs shall be continued. In the second group of patients, the reason why non-pharmacological therapy is not appropriate was given. Mathematical data analysis was performed.

Results:
Out of 129 refractory patients, 47 (36.4%) were indicated for the educational interview by at least one physician and 39 (30.2%) patients were indicated by two physicians. Out of 39 children, resection was considered in 15 patients, a disconnection procedure in 1, vagus nerve stimulation implantation in 31 and ketogenic diet in 26 patients. In 82 children (63.6%), the interview was not indicated.

Conclusion:
Patients with pharmacoresistant epilepsy who have seizures were identified at our department and eligible candidates were directed to an educational interview concerning non-pharmacological therapy. The study is to be followed with a prospective part where a specific therapeutic procedure will be implemented.

Key words:
pharmacoresistant epilepsy – refractory epilepsy – epilepsy surgery – ketogenic diet – vagus nerve stimulation

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Zdroje

1. Kwan P, Arzimanoglou A, Berg AT et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc task force of the ILAE commission on therapeutic strategies. Epilepsia 2010; 51(6): 1069– 1077. doi: 10.1111/ j.1528-1167.2009.02397.x.

2. Arts WFM, Brouwer OF, Peters ACB et al. Course and prognosis of childhood epilepsy: 5-year follow-up of the Dutch study of epilepsy in childhood. Brain 2004; 127(8): 1774– 1784. doi: 10.1093/ brain/ awh200.

3. Shields WD. Catastrophic epilepsy in childhood. Epilepsia 2000; 41 (Suppl 2): S2– S6.

4. Ben-Ari Y, Dudek FE. Primary and secondary mechanisms of epileptogenesis in the temporal lobe: there is a before and an after. Epilepsy Curr 2010; 10(5): 118– 125. doi: 10.1111/ j.1535-7511.2010.01376.x.

5. Brázdil M, Hadač J. Definice farmakorezistentní epilepsie, příčiny intraktability. In Brázdil M, Hadač J, Marušič P (eds). Farmakorezistentní epilepsie. Praha: Triton 2004: 13– 22.

6. Thompson PJ, Duncan JS. Cognitive decline in severe intractable epilepsy. Epilepsia 2005; 46(11): 1780– 1787. doi: 10.1111/ j.1528-1167.2005.00279.x.

7. Brázdil M. Léčba epilepsie – update. Med praxi 2011; 8(11): 478– 480.

8. Brodie MJ, Kwan P. Staged approach to epilepsy management. Neurology 2002; 58 (8 Suppl 5): S2– S8. doi: 10.1212/ WNL.58.8_suppl_5.S2.

9. Holland KD, Glauser TA. Response to carbamazepine in children with newly diagnosed partial onset epilepsy. Neurology 2007; 69(6): 596– 599. doi: 10.1212/ 01.wnl.0000267274.69619.f3.

10. Lamberink HJ, Boshuisen K, Rijen PC et al. Changing profiles of pediatric epilepsy surgery candidates over time: a nationwide single-center experience from 1990 to 2011. Epilepsia 2015; 56(5): 717– 725. doi: 10.1111/ epi.12974.

11. Barba C, Specchio N, Guerrini R et al. Increasing volume and complexity of pediatric epilepsy surgery with stable seizure outcome between 2008 and 2014: A nationwide multicenter study. Epilepsy Behav 2017; 75: 151– 157. doi: 10.1016/ j.yebeh.2017.08.010.

12. Bien CG, Raabe AL, Schramm J et al. Trends in presurgical evaluation and surgical treatment of epilepsy a tone centre from 1988– 2009. J Neurol Neurosurg Psychiatry 2013; 84(1): 54– 61. doi: 10.1136/ jnnp-2011-301763.

13. Brázdil M. Proměny epileptochirurgie ve 21. století. Neurol praxi 2015; 16(2): 77– 79.

14. Téllez-Zenteno JF, Dhar R, Wiebe S. Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis. Brain 2005; 128(5): 1188– 1198. doi: 10.1093/ brain/ awh449.

15. Kuba R, Brázdil M, Novák Z et al. Dlouhodobá účinnost resekčních epileptochirurgických zákroků 5 let od operace. Neurol praxi 2008; 9(3): 166– 170.

16. Hanáková P, Brázdil M, Novák Z et al. Long-term outcome and predictors of resective surgery prognosis in patients with refractory extratemporal epilepsy. Seizure 2014; 23(4): 266– 273. doi: 10.1016/ j.seizure.2013.12.003.

17. Jeha LE, Najm I, Bingaman W et al. Surgical outcome and prognostic factors of frontal lobe epilepsy surgery. Brain 2007; 130(2): 574– 584. doi: 10.1093/ brain/ awl 364.

18. Spencer SS, Berg AT, Vickrey BG et al. Initial outcomes in the multicenter study of epilepsy surgery. Neurology 2003; 61(12): 1680– 1685.

19. D‘Argenzio L, Colonnelli MC, Harrison S et al. Seizure outcome after extratemporal epilepsy surgery in childhood. Dev Med Child Neurol 2012; 54(11): 995– 1000. doi: 10.1111/ j.1469-8749.2012.04381.x.

20. Téllez-Zenteno JF, Ronquillo LH, Moien-Afshari Fet al. Surgical outcomes in lesional and non-lesional epilepsy: a systematic review and meta-analysis. Epilepsy Res 2010; 89(2– 3): 310– 318. doi: 10.1016/ j.eplepsyres.2010.02.007.

21. Bodin E, Le Moing AG, Bourel-Ponchel E et al. Vagus nerve stimulation in the treatment of drug resistant epilepsy in 29 children. Eur J Paediatr Neurol 2016; 20(3): 346– 351. doi: 10.1016/ j.ejpn.2016.01.011.

22. Rychlicki F, Zamponi N, Trignani R et al. Vagus nerve stimulation: clinical experience in drug-resistant pediatric epileptic patients. Seizure 2006; 15(7): 483– 490. doi: 10.1016/ j.seizure.2006.06.001.

23. Orosz I, McCromick D, Zamponi N et al. Vagus Nerve stimulation for drug-resistant epilepsy: a European long-term study up to 24 months in 347 children. Epilepsia 2014; 55(10): 1576– 1584. doi: 10.1111/ epi.12762.

24. Ryzí M, Brázdil M, Novák Z et al. Long-term vagus nerve stimulation in children with focal epilepsy. Acta Neurol Scand 2013; 127(5): 316– 322. doi: 10.1111/ ane.12009.

25. Alexopoulos AV, Kotagal P, Loddenkemper T et al. Long-term results with vagus nerve stimulation in children with pharmacoresistant epilepsy. Seizure 2006; 15(7): 491– 503. doi: 10.1016/ j.seizure.2006.06.002.

26. Brázdil M, Hadač J, Marusič P et al (eds). Farmakorezistentní epilepsie. 2. vyd. Praha: Triton 2011.

27. Lefevre F, Aronson N. Ketogenic diet for the treatment of refractory epilepsy in children: a systematic review of efficacy. Pediatrics 2000; 105(4): E46.

28. Laxer KD, Trinka E, Hirsch LJ et al. The consequences of refractory epilepsy and its treatment. Epilepsy Behav 2014; 37: 59– 70. doi: 10.1016/ j.yebeh.2014.05.031.

29. Picot MC, Baldy-Moulinier M, Daurès JP et al. The prevalence of epilepsy and pharmacoresistant epilepsy in adults: a population-based study in a western European country. Epilepsia 2008; 49(7): 1230– 1238. doi: 10.1111/ j.1528-1167.2008.01579.x.

30. Choi H, Carlino R, Heiman G et al. Evaluation of duration of epilepsy prior to temporal lobe epilepsy surgery during the past two decades. Epilepsy Res 2009; 86(2– 3): 224– 227. doi: 10.1016/ j.epilepsyres.2009.05.014.

31. Berg AT, Zelko FA, Levy SR et al. Age at onset of epilepsy, pharmacoresistance, and cognitive outcomes. A prospective cohort study. Neurology 2012; 79(13): 1384– 1391. doi: 10.1212/ WNL.0b013e31826c1b55.

32. Hoei-Hansen CE, Mathiasen R, Uldall P. Unexpected marked seizure improvement in paediatric epilepsy surgery candidates. Seizure 2017; 45: 70– 73. doi: 10.1016/ j.seizure.2016.11.020.

33. Bien CG, Schulze-Bonhage A, Soeder BM et al. Assessment of the long-term effects of epilepsy surgery with three different reference groups. Epilepsia 2006; 47(11): 1865– 1869. doi: 10.1111/ j.1528-1167.2006.00813.x.

34. Ryvlin P, Cross JH, Rheims S. Epilepsy surgery in children and adults. Lancet Neurol 2014; 13(11): 1114– 1126. doi: 10.1016/ S1474-4422(14)70156-5.

35. Pestana Knight EM, Schiltz NK, Bakaki PM et al. Increasing utilization of pediatric epilepsy surgery in the United States between 1997 and 2009. Epilepsia 2015; 56(3): 375– 381. doi: 10.1111/ epi.12912.