내측두경화를 동반한 측두엽 간질환자에서 항 간질약제 치료 후 첫 1년간 발작횟수와 다음 1년간 년간 발작횟수 간의 차이 및 상관 관계

Abstract

Determination of medical intractability is primarily essential for planning a surgical treatment of epilepsy. Questions regarding intractability include the optimum duration of adequate antiepileptic drug (AED) treatment and the tolerable seizure frequency. Unfortunately, there is no established guideline for determination of medical intractability in terms of the duration or the tolerability of AED resistance. In temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS), a well-known surgically remediable epileptic syndrome, the investigation of relationship between short-term and long-term AED response may help us finding a way to solve the above questions. Methods：From 2 epilepsy centers, 86 patients with TLE demonstrating MTS on MRI were evaluated. All of them were on AED treatment for at least 2 years. We investigated seizure free rate for 1st 1 year, for next 1 year and that for two years. We compared seizure number of 1st 1 year with that of 2nd 1 year and analyzed correlation coefficiency between seizure numbers of the two periods. Paired-t-test and Pearson correlation test were performed for statistical analysis. Results：Two year terminal remission rate was 3.5%. Remission rate for the 1st 1 year was 4.7% whereas in the 2nd 1 year it rose to 16.3%. Mean seizure number of 1st one year was 34.9 (±48.1) and that of next one year was 27.0 (±45.5). Mean paired differences between seizure numbers of the two periods was 7.95 (±28.60)(95% confidence interval：1.82-14.09) which was statistically significant (p＝0.012). Pearson correlation coefficiency was 0.815 between seizure numbers of the two periods (p≤0.01). Conclusion：In TLE with MTS, seizure free outcome was very poor. However, seizure-free rate rose and seizure number declined as AED treatment duration was prolonged for 2 years. Seizure number of 1st year may predict that of 2nd year. To establish an appropriate index time for considering medical intractability, further studies on longer-term outcome by AED treatment should be recommended in addition to studies on adequate tolerability of AED resistance.