Résumé
BACKGROUNDS: Temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) is not always intractable to antiepileptic drugs (AEDs). To identify the responsiveness to AEDs and related clinical factors in TLE-HS, we performed this study. METHODS: Consecutive 100 (51 men, mean age=30.2+/-6.6, age range=19-50) patients with TLE-HS were divided into two groups by their responsiveness to AEDs. Intractable TLE-HS was defined if they had any seizures for the preceding year with at least two AEDs. Clinical factors were analyzed to find the association of the responsiveness to AEDs. RESULTS: Intractable TLE-HS was found in 68% of patients. The younger age of onset (12+/-4 vs. 31+/-8 years, p<0.0001), longer duration of epilepsy (17+/-6 vs. 2+/-1 years, p<0.0001), more than five tonic-clonic seizures (GTCs) with secondary generalization (29.4 vs. 6.3%, p=0.0009) and bilateral epileptiform abnormalities on EEG (30.9 vs 6.3%, p=0.0054) were significantly correlated with the intractable TLE-HS. According to multiple logistic regression analysis, bilateral epileptiform abnormalities on EEG (adjusted OR=9.4, 95% CI: 1.98~44.76) and more than five GTC (adjusted OR=7.7, 95% CI: 1.60~33.39) were independently related with poor responsiveness to AEDs in TLE-HS. CONCLUSIONS: The presence of hippocampal sclerosis does not necessarily mean intractability to AEDs. The clinical variables related with the poor response to ADEs in TLE-HS are more than five GTCs and bilateral epileptiform abnormalities on EEG.