Gerçek Dirençli Epilepsi Mi? Üçüncü Basamak Merkezde Hastaların Takibi

Yıl 2018, Cilt: 5 Sayı: 1, 10 - 12, 25.07.2018

Yasemin Ünal Gülnihal Kutlu

Öz

Refrakter Epilepsinin
erken tanısı, alternatif tedavi yaklaşımlarını uygulamak için çok önemlidir.
Bununla beraber, refrakter epilepsinin yanlış tanısı sıktır. Yalancı-Refrakter
Epilepsi yanlış tanı, yanlış ve/veya düşük doz antiepileptik ilaç kullanımı ve
hastanın kötü uyumuna bağlı nöbet kontrolündeki yetersizliktir. Bu çalışmanın
amacı, gerçek ve yalancı refrakter epilepsi hastalarını incelemektir. Dört yüz
kırk dokuz hastanın dosyaları (Mart 2014-Ocak 2017) aynı nörolog tarafından
geriye dönük olarak incelenmiştir ve gerçek refrakter ve yalancı refrakter
epilepsi hastaları saptanmıştır. Yetmiş sekiz (%66.1) hastada gerçek refrakter
epilepsi tespit edilmiştir. On dört (%11.9) hastada yanlış tanı mevcuttu; on
iki (%10.2) hastada uygun olmayan tedavi alıyordu; onbir hasta (%9.3) yetersiz
dozda antiepileptik ilaç kullanıyordu, monoterapi alan üç hastada yetersiz
tedavi uyumuna sahipti.  Gerçek ve
yalancı refrakter epilepsinin ayırıcı tanısı yetersiz tedavi yaklaşımlarında ve
gerçek refrakter epilepsinin gelecek tedavisinde çok önemlidir.

Anahtar Kelimeler

Dirençli Epilepsi, Epilepsi, Yalancı Refrakter Epilepsi

Is It True Refractory Epilepsy or Not? Follow up of Patients in Tertiary Epilepsy Unit

Öz

Early recognition of
refractory epilepsy is so important to apply alternative therapeutic approach
to the patient. However, misdiagnosis of refractory epilepsy is common.
Pseudo-Refractory epilepsy is defined as seizures inadequately treated due to
incorrect diagnosis, use of incorrect and/or low dose antiepileptic drug (AED)
and poor compliance of patients. The aim of the present paper was to
investigate the patients with true and pseudo-refractory epilepsy. The files of
four hundred and forty-nine patients (March 2014-January 2017) reviewed by the
same neurologist retrospectively and the patients with true and
pseudo-refractory epilepsy were determined. 
Seventy-eight (66.1%) of the patients was with true refractory epilepsy.
Fourteen (11.9%) patients had misdiagnosis; twelve (10.2%) patients used
inappropriate medicine; eleven (9.3%) patients was treated with inadequate dose
of antiepileptic drug; three patients had poor compliance of treatment received
monotherapy. Differentiation of pseudo-refractory and true refractory epilepsy
are very important for avoiding unnecessary treatment approaches and future
management of true refractory epilepsy.  

Anahtar Kelimeler

Epilepsy, Intractable Epilepsy, Pseudo Refractory Epilepsy

Kaynakça

• 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):1069-77.
• 2. Smith D, Defalla BA, Chadwick DW. The misdiagnosis of epilepsy and the management of refractory epilepsy in a specialist clinic. QJM. 1999;92:15.
• 3. Perruca E. Pharmacoresistance in epilepsy: How should be defined. CNS Drugs. 1998:10(3);171-9.
• 4. Begley CE, Famulari M, Annegers JF, et al. The cost of epilepsy in the United States: an estimate from population-based clinical and survey data. Epilepsia. 2000;41(3):342-51.
• 5. Kwan P, Schachter SC, Brodie MJ. Drug-resistant epilepsy. N Engl J Med. 2011;365(10):919-26.
• 6. Szaflarski JP, Ficker DM, Cahill WT, Privitera MD. Four-year incidence of psychogenic nonepileptic seizures in adults in hamilton county, OH. Neurology. 2000; 55(10):1561-3.
• 7. Gates JR, Ramani V, Whalen S, Loewenson R. Ictal characteristics of pseudoseizures. Arch Neurol. 1985;42(12):1183-7.
• 8. Neligan A, Holdright DR, Rugg-Gunn FJ, Sander JW. A case of mistaken mesial temporal identity. BMJ. 2009;338:b2258.
• 9. Devinsky O. Patients with refractory seizures. N Engl J Med. 1999;340(20):1565-70.
• 10. Cramer JA, Glassman M, Rienzi V. The relationship between poor medication compliance and seizures. Epilepsy Behav. 2002;3(4):338-342.
• 11. Kyngäs H. Predictors of good compliance in adolescents with epilepsy. Seizure. 2001;10(8):549-53.
• 12. Schuele SU, Lüders HO. Intractable epilepsy: management and therapeutic alternatives. Lancet Neurol. 2008;7(6):514-24.
• 13. Hitiris N, Mohanraj R, Norrie J, et al. Predictors of pharmacoresistant epilepsy. Epilepsy Res. 2007;75(2-3):192-6.