Epilepsia farmacorresistente. Experiencia quirúrgica en el Instituto de Neurología y Neurocirugía (2012-2018) / Drug-resistant epilepsy. Experience with surgical treatment at the Institute of Neurology and Neurosurgery, Havana, Cuba (2012-2018)
La epilepsia es la alteración neurológica más frecuente en la población general. El objetivo de la cirugía de epilepsia es garantizar la ausencia o disminución de crisis, lo que se logra en el 80 % de los pacientes.
La edad del 44,8 % de los pacientes estuvo entre 21 y 30 años, el 62,1 % era del sexomasculino y el 82,8 % tenía color de piel blanca, el 31 % presentó entre 11 y 20 años de evolución. En el 75,9 % la epilepsia era lesional, el 55,2 % con localización temporal y en el 86,2 % se demostró congruencia clínica. Se utilizaron técnicas resectivas en 87,6 %. El 82,8 % no presentó crisis postoperatorias. En 62,1 % no se presentaron complicaciones. A los 3, 6 y 12 meses después de la intervención entre el 55 al 82 % de los pacientes estudiados se clasificaron como Engel clase I y clase II.
Epilepsy is the most frequent neurological alteration in the general population. The objective of epilepsysurgery is to guarantee the absence or the decrease of seizures which is achieved in 67 % and 80 % of patients.
Of all the patients studied, 44,8 % were between 21 and 30 years old, 62,1 % were male and 82,8 % were white. Also, 31 % were between 11 and 20 years of follow-up. Epilepsy was lesional in 75,9 % of patients whereas in 55,2 % of them it was located in the temporal lobe; clinical congruence was demonstrated in 86,2 % of patients. Resective techniques were used in 87,6 % of them. Besides, 82,8 % had no postoperative seizures. There were no complications in 62,1 % of patients. On the other hand, 55 and 82 % of the patients studied were classified as Engel Class I and Engel Class II at 3, 6 and 12 months after surgical intervention.
Conclusions:
The use of resective techniques and the absence of seizures after surgery predominated in our study. No significant relationship was found between surgical outcome, etiology of epilepsy and clinical congruence. The presence of a focal lesion of the temporal lobe was a factor for good outcome.