Clinical Analysis Of Drug Effects For Patients With Epilepsy

Objective: International League Against Epilepsy(ILAE) has developed a unified definition of drug-resistant epilepsy from the perspective of therapeutic strategies. In clinical practice, a proportion of patients not reaching the standard of “seizure-free” can achieve the goal by adjusting the antiepileptic drug treatment programs, suggesting these patients not to be with so-called drug-resistant epilepsy, but for some reasons to be treated with insufficient anti-epileptic drugs. This essay aims to evaluate the treatment outcomes of patients with epilepsy according to the latest definition of drug-resistant epilepsy by ILAE, and to analyze the clinical characteristics and reasons for unsuccessful anti-epileptic drug treatment of pseudo-refractory epilepsy.Methods: Patients diagnosed with epilepsy and treated with antiepileptic drugs in the outpatient department of Epilepsy Center in Guangdong 999 Brain Hospital from March 2003 to June 2015, who get through more than12-month follow-up period were enrolled in this study. All the patients were evaluated over their effectiveness according to the definition of drug-resistant epilepsy by ILAE. If the duration of seizure-free has not yet reached 12 months or three times the longest interval between two seizures(when seizure frequency> 4 months) before treatment after monotherapy or combination therapy with full dose and full course of medication and with correct selection of at least two kinds of tolerable antiepileptic drugs according to the type of seizure, the epilepsy is defined as “drug-resistant epilepsy”. Those whose treatment effect do not conform with seizure-free and whose drug treatment programs do not meet the criteria above were analyzed, including the basic characteristics, clinical manifestation, drug strategy and the reasons for unsuccessful treatment.Results: The clinical characteristics of pseudo-refractory epilepsy are as follows: adults and children consist of the most of the population; men overweight women slightly in number; most patients were diagnosed with cryptogenic epilepsy; VPA is the most common one among all kinds of anti-epileptic drugs; a proportion of patients have comorbidities. The most common causes of pseudo-refractory epilepsy patients for unsuccessful epilepsy drug therapy include poor adherence to anti-epilepsy drug therapy,inadequate antiepileptic drug dose and treatment period, patients with predisposing factors to epilepsy, non-top choice of antiepileptic drugs,related psychological problems and so on.Conclusion: Epilepsy that does not reach seizure-free is not exactly the same as drug-resistant epilepsy. Therefore, in clinical practice, the reasons for poor long-term outcomes of patients with epilepsy, especially those conform with the features of pseudo-refractory epilepsy described above should be analyzed to develop more adequate anti-epileptic treatment programs. In addition, clinicians and patients should concentrate on regulating their behaviors from the above point of view from the beginning of the first attending, so that more patients can achieve seizure-free.