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Clínica de Epilepsia | Trabalhos em Congressos

ANTI-EPILEPTIC DRUG REGIMEN STATUS BEFORE AND AFTER CORTICO-AMYGADALO-HIPPOCAMPECTOMY IN PATIENTS WITH UNILATERAL MESIAL TEMPORAL SCLEROSIS

Baldauf CM, Cukiert A, Burattini JA, Mariani PP, Camara RB, Seda L, Argentoni-Baldochi M, Baise-Zung C, Forster CR, Mello VA.

Department of Neurology and Neurosurgery, Epilepsy Surgery Program, Hospital Brigadeiro and Clinica de Epilepsia de Sao Paulo, Sao Paulo SP, Brazil

Rationale: The surgical outcome after temporal lobe resections regarding seizure frequency has been extensively reported over the last decades. On the other hand, the status of the anti-epileptic drug (AED) regimen of these patients has been poorly studied, especially over long follow-up periods. We describe the status of the AED regimen in a series of patients with mesial temporal sclerosis submitted to cortico-amygdalo-hippocampectomy.

Methods: Forty one patients with refractory unilateral temporal lobe epilepsy were studied. Mean post-operative follow-up time was 4.3+1.1 years. MRI disclosed unilateral mesial temporal sclerosis (MTS) in all patients. All patients had interictal EEG recordings. All patients were submitted to cortico-amygdalo-hippocampectomy at the side determined by MRI. The AED regimen status was recorded before and at the last follow-up visit.

Results: Thirty-nine patients (95, 1%) were classified as Engel’s Class I (70,6% Engel I-A) and two (4.9%) as Engel's Class II, postoperatively. Eleven patients (26.8%) were not taking any AED. The pre- and post-operative AED regimen status could be summarized as follows:

AED

Before Surgery

After Surgery

 

N

Daily Dose Mean (mg)

N

Daily Dose Mean (mg)

Carbamazepine

27

1.059,3

23

608,7

Fenobarbital

22

113,6

14

96,4

Phenytoin

10

280,0

4

200,0

Oxcarbazepine

8

900,0

0

-

Valproic Acid

3

733,3

1

1.000,0

Clonazepam

3

2,0

1

4,0

Lamotrigine

2

125,0

0

-

Clobazam

1

20

3

20

Topiramate

1

150

0

-

Gabapentine

1

1.200

0

-

Discussion: One quarter of the patients were taking no AED at late follow-up. The majority of the others were taking much lower dosages of AED. Valproic acid was the only AED more extensively used post-operatively in this series; it is currently used in the treatment of post-operative hypomania seen in some of these patients.