Gerçek Dirençli Epilepsi Mi? Üçüncü Basamak Merkezde Hastaların Takibi

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

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.

Keywords:

Epilepsy, Intractable Epilepsy, Pseudo Refractory Epilepsy,

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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.