Prevalence of depression among epileptic patients at Phramongkutklao Hospital.

OBJECTIVES: To determine the prevalence of depression among epileptic patients in Phramongkutklao Hospital and to find the factors associated with depression. MATERIAL AND METHOD: One hundred and ten epileptic patients were enrolled and 60 patients met the inclusion criteria. These subjects were screened with Thai Geriatric Depressive Scale (TGDS) and were interviewed. Demographic data that effect depression were evaluated. RESULTS: During the 1-year study period, 60 of 110 patients diagnosed epilepsy were eligible. Prevalence of depression was 38.3%, which is similar to previous studies. Mild depression was found in 65.2% and moderate 34.8%, without severe depression. Comparing between male and female, there was no statistical significant difference (p = 0.75). The age group that compared between age equal or less than 25 years and more than 25 years had no statistical significant difference (p = 0.77). Other variables were not found to be significant risk factors of depression among epileptic patients including duration of seizures [equal or less than 5 and more than 5 per year (p = 0.43)], type of seizures [generalized tonic-clonic seizures and partial seizures (p = 0.69)], and number of antiepileptic drugs [monotherapy and polytherapy (p = 0.44)]. CONCLUSION: Prevalence of depression among epileptic patients was 38.3%, divided between mild (65.2%) and moderate (34.8%). There were no significant risk factors correlated with depression. Epileptic patients should be made aware of this and seek prompt treatment for depression.

Oxcarbazepine as add-on therapy in Thai epileptic patients with refractory partial seizures.

OBJECTIVES: To evaluate efficacy and safety of oxcarbazepine (OXC) as add-on therapy in Thai refractory epileptic patients. MATERIAL AND METHOD: A randomized, double-blind clinical trial was conducted in outpatients of the Epilepsy Clinic of Phramongkutklao Hospital. OXC in the doses of 600 or 1200 mg/d were added to 39 refractory epileptic patients with the median baseline seizure frequency of at least 2 per 28 days. RESULTS: Of 35 patients who completed the 98-day treatment period, 4 became seizure free. A reduction in median seizure frequency of 47% and 58% was observed in patients in the 600 and 1,200 mg OXC/d groups, respectively. Among them, 44% and 53% demonstrated > or = 50% reduction in median seizure frequency. About 85% of patients in each group reported one or more mild to moderate adverse events. CONCLUSION: OXC in the doses of 600 and 1200 mg/d appear to be safe and effective as adjunctive therapy in Thai refractory epileptic patients. Further studies are needed to confirm its long-term efficacy and tolerability.

Epilepsy surgery in children and adolescence; Phramongkutklao College of Medicine's experience.

OBJECTIVES: To evaluate the safety and efficacy of epilepsy surgery in children and adolescence at Comprehensive Epilepsy Center, Phramongkutklao College of Medicine. MATERIAL AND METHOD: Children and adolescents, who underwent epilepsy surgery at Comprehensive Epilepsy Center, Phramongkutklao College of Medicine were identified from the epilepsy surgery database. The following parameters were evaluated: age at surgery, duration of seizure prior to surgery, presurgical work up, presurgical as well as postsurgical neurological/ seizure status and neuropathology (if applicable). All follow-up data were obtained through clinic visits. RESULTS: Fifteen children who underwent epilepsy surgery between January 1, 2003 and March 31, 2005 were identified. Age at surgery ranged from 2.5 years to 19 years (mean age=8.2 years). Seizure duration prior to surgery ranged from 1 year to 17 years (mean=4.7 years). Eight patients (53%) had partial seizures and underwent excisional procedures [5 temporal lobectomy, 2 left frontal corticectomy, and 1 left functional hemispherectomy]. Seven patients (47%) had generalized seizures and underwent anterior 2/3 corpus callosotomy. Pathological information was available for all 8 cases with partial epilepsy. Four out of eight cases with pathological information demonstrated cortical dysplasia, four revealed hippocampal sclerosis, and two patients had dysembryoplastic neuroepithelial tumor (DNET). At follow-up, all 5 patients with temporal lobectomy and a child who underwent functional hemispherectomy were seizure free (follow up period 3-31 months). Two children with extratemporal resective surgery [left frontal corticectomy] showed remarkable improvement with rare breakthrough seizures (follow up period= 3 and 19 months respectively). Four out of seven patients with corpus collosotomy had worthwhile improvement of seizures (follow up period=4-19 months), while another two children were seizure free during short-termed follow up postoperatively (follow up period=1 and 2 months). All patients did not have significant neurological deterioration or worsening of seizure after the surgery. CONCLUSION: Resective epilepsy surgery in Thai pediatric populations in the authors' experience seems to be safe and effective in selected patients. Most children who underwent callosotomy had a significant reduction in intensity and frequency of tonic, atonic, and tonic-clonic seizures. Dual pathology was common in refractory temporal lobe epilepsy with hippocampal sclerosis. Although the study sample was small, it did advocate several larger studies with the same findings.