Tratamento clínico da epilepsia resistente

Damasceno, Benito Pereira; Campos Jr., Sizenando da Silva; Martins, Luiz Fernando; Melo-Souza, Sebastião Eurico de

doi:10.1590/S0004-282X1988000400002

Resumos

Foram estudados 34 casos de epilepsia de difícil controle, encaminhados ao Grupo de Trabalho de Epilepsia (GTE) do Instituto de Neurologia de Goiânia de 1984 a 1986. Todos eram submetidos a reavaliação neurológica. Vinte e três dos 34 pacientes tinham crises parciais complexas. A maioria foi tratada com carbamazepina, difenil-hidantoína e ácido valpróico, em forma monoterápica ou associada entre si. Obteve-se redução de mais de 80% da freqüência das crises em 22 pacientes (64,7%), além de leve melhora da qualidade de vida. Os autores concluem sobre as vantagens de uma equipe especializada, multidisciplinar, na abordagem da epilepsia rebelde e ressaltam a necessidade de: a. um correto diagnóstico das crises, seguido do uso da medicação apropriada, por tempo suficiente (mínimo de 0 meses) e em dose adequada (até a dose máxima tolerável), abandonando-a só depois do controle de sua concentração sérica; b. um bom engajamento do paciente e de sua família no tratamento.

The authors analysed 34 cases of resistant epilepsy (20 males and 14 females, mean age 23 years), treated clinically between February/1984 and May/1986. The patients underwent neurological, neuropsychological, psychological, psychiatric, cerebrospinal fluid, electroencephalographic, tomographic and/or angiographic examination. Most of the patients had complex partial seizures. The etiology was unknown in 19 patients (55.8%), probable neurocysticercosis in 6, perinatal hypoxia in 5, delivery trauma in 3 and probable sequelae of encephalitis in 2 patients. There was a clear past history of infantile febrile convulsion in 2 patients. Most patients received carbamazepine (mean dose 24.5 mg/kg/day), phenytoin (5 mg/kg and valproic acid (28 mg/kg) as monotherapy or in association. Twenty-two patients (64.7%) had more than 80% decrease of the seizure frequency. Nine resistant epilepsy-cases (24.5%) were evaluated as candidates for surgical therapy. The authors concluded that the resistant epilepsy is best managed by a specialised, multidisciplinary team, and pointed out the need of a correct diagnosis of the seizure type, an adequate drug therapy and a good engagement of the patient and his family in the treatment.

Benito Pereira Damasceno^I; Sizenando da Silva Campos Jr.^II; Luiz Fernando Martins^III; Sebastião Eurico de Melo-Souza^IV

^IProfessor Assistente do Departamento de Neurologia da Faculdade de Ciências Médicas da UNICAMP e Neurologista do Instituto de Neurologia de Goiânia (ING)

^IIResidente de Neurocirurgia do ING

^IIINeurocirurgião do ING

^IVProfessor Adjunto do Departamento de Clínica Médica (Disciplina de Neurologia) da Faculdade de Medicina da Universidade Federal de Goiás e Neurologista do ING

RESUMO

Foram estudados 34 casos de epilepsia de difícil controle, encaminhados ao Grupo de Trabalho de Epilepsia (GTE) do Instituto de Neurologia de Goiânia de 1984 a 1986. Todos eram submetidos a reavaliação neurológica. Vinte e três dos 34 pacientes tinham crises parciais complexas. A maioria foi tratada com carbamazepina, difenil-hidantoína e ácido valpróico, em forma monoterápica ou associada entre si. Obteve-se redução de mais de 80% da freqüência das crises em 22 pacientes (64,7%), além de leve melhora da qualidade de vida. Os autores concluem sobre as vantagens de uma equipe especializada, multidisciplinar, na abordagem da epilepsia rebelde e ressaltam a necessidade de: a. um correto diagnóstico das crises, seguido do uso da medicação apropriada, por tempo suficiente (mínimo de 0 meses) e em dose adequada (até a dose máxima tolerável), abandonando-a só depois do controle de sua concentração sérica; b. um bom engajamento do paciente e de sua família no tratamento.

SUMMARY

The authors analysed 34 cases of resistant epilepsy (20 males and 14 females, mean age 23 years), treated clinically between February/1984 and May/1986. The patients underwent neurological, neuropsychological, psychological, psychiatric, cerebrospinal fluid, electroencephalographic, tomographic and/or angiographic examination. Most of the patients had complex partial seizures. The etiology was unknown in 19 patients (55.8%), probable neurocysticercosis in 6, perinatal hypoxia in 5, delivery trauma in 3 and probable sequelae of encephalitis in 2 patients. There was a clear past history of infantile febrile convulsion in 2 patients. Most patients received carbamazepine (mean dose 24.5 mg/kg/day), phenytoin (5 mg/kg and valproic acid (28 mg/kg) as monotherapy or in association. Twenty-two patients (64.7%) had more than 80% decrease of the seizure frequency. Nine resistant epilepsy-cases (24.5%) were evaluated as candidates for surgical therapy. The authors concluded that the resistant epilepsy is best managed by a specialised, multidisciplinary team, and pointed out the need of a correct diagnosis of the seizure type, an adequate drug therapy and a good engagement of the patient and his family in the treatment.

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Departamento de Neurologia, Faculdade de Ciências, UNICAMP - Caixa Postal 6111 - 13083 Campinas SP - Brasil.

1. Adams RD, Victor M - Principles of Neurology. Ed 3. McGraw-Hill, New York, 1985.
2. Aminoff MJ - Electrodiagnosis in Clinical Neurology. Churchill Livingstone, New York, 1980.
3. Bruni J, Albright PS - Review: the clinical pharmacology of antiepileptic drugs. Clir Neuropharmacol 7: 1, 1984.
4. Delgado-Escueta AV, Treiman DM, Walsh GO - The treatable epilepsies. N Engl J Med 308: 1576, 1983.
5. Eeg-Olofsson O - Childhood epilepsy: treatment principles. Opuscula Medica 26:71, 1981.
6. Gomez MR, Klass DW - Epilepsies of infancy and childhood. Ann Neurol 13: 113, 1983.
7. Kifrboe E - Medical prognosis of epilepsy. In Vinken PS, Bruyn GW, eds: Handbook of Clinical Neurology. Vol 15. North-Holland, Amsterdam, 1974, pg 783.
8. Kühl, Kifrboe E, Lund M - The prognosis of epilepsy with special reference to trafic security. Epilepsia 8: 195, 1967.
9. Lakemedelsbiverkningskommittens meddelande nr 36/37 (Sweden): Tema om antiepileptika - Sversikt av biverkningar de senaste elva aren. Läkartidningen 79: 2646, 1982.
10. Porter RJ - Epilepsy: 100 elementary principles. WB Saunders, Philadelphia, 1984.
11. Proposal for revised clinical and electroencephalographic classification of epileptic seizures: Comission on Classification and Terminology of the International League Against Epilepsy. Epilepsia 22: 489, 1981.
12. Reynolds E - Chronic antiepileptic toxicity: a review. Epilepsia 16: 319, 1975.
13. Rodin EA - The prognosis of patients with epilepsy. Charles C Thomas, Springfield, 1968.
14. Silfvenius H, Blom S, Nilsson L-G, Christianson S-A - Observations on verbal, pictorial and stereognostic memory in epileptic patients during intracarotid Amytal testing. Acta Neurol Scand 99: 57, 1984.
15. So EL, Penry JK - Epilepsy in adults. Ann Neurol 9 :3, 1981.
16. Strobos RRJ - Prognosis in convulsive disorders. Arch Neurol 1: 216, 1959.
17. Theodore WH, Porter RJ - Removal of sedative-hypnotic antiepileptic drugs from the regimens of patients with intractable epilepsy. Ann Neurol 13: 320, 1983.

Tratamento clínico da epilepsia resistente

Clinical treatment of resistant epilepsy

Datas de Publicação

Publicação nesta coleção
21 Jun 2011
Data do Fascículo
Dez 1988

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Adams RD, Victor M - Principles of Neurology. Ed 3. McGraw-Hill, New York, 1985.

[2] 2. Aminoff MJ - Electrodiagnosis in Clinical Neurology. Churchill Livingstone, New York, 1980.

[3] 3. Bruni J, Albright PS - Review: the clinical pharmacology of antiepileptic drugs. Clir Neuropharmacol 7: 1, 1984.

[4] 4. Delgado-Escueta AV, Treiman DM, Walsh GO - The treatable epilepsies. N Engl J Med 308: 1576, 1983.

[5] 5. Eeg-Olofsson O - Childhood epilepsy: treatment principles. Opuscula Medica 26:71, 1981.

[6] 6. Gomez MR, Klass DW - Epilepsies of infancy and childhood. Ann Neurol 13: 113, 1983.

[7] 7. Kifrboe E - Medical prognosis of epilepsy. In Vinken PS, Bruyn GW, eds: Handbook of Clinical Neurology. Vol 15. North-Holland, Amsterdam, 1974, pg 783.

[8] 8. Kühl, Kifrboe E, Lund M - The prognosis of epilepsy with special reference to trafic security. Epilepsia 8: 195, 1967.

[9] 9. Lakemedelsbiverkningskommittens meddelande nr 36/37 (Sweden): Tema om antiepileptika - Sversikt av biverkningar de senaste elva aren. Läkartidningen 79: 2646, 1982.

[10] 10. Porter RJ - Epilepsy: 100 elementary principles. WB Saunders, Philadelphia, 1984.

[11] 11. Proposal for revised clinical and electroencephalographic classification of epileptic seizures: Comission on Classification and Terminology of the International League Against Epilepsy. Epilepsia 22: 489, 1981.

[12] 12. Reynolds E - Chronic antiepileptic toxicity: a review. Epilepsia 16: 319, 1975.

[13] 13. Rodin EA - The prognosis of patients with epilepsy. Charles C Thomas, Springfield, 1968.

[14] 14. Silfvenius H, Blom S, Nilsson L-G, Christianson S-A - Observations on verbal, pictorial and stereognostic memory in epileptic patients during intracarotid Amytal testing. Acta Neurol Scand 99: 57, 1984.

[15] 15. So EL, Penry JK - Epilepsy in adults. Ann Neurol 9 :3, 1981.

[16] 16. Strobos RRJ - Prognosis in convulsive disorders. Arch Neurol 1: 216, 1959.

[17] 17. Theodore WH, Porter RJ - Removal of sedative-hypnotic antiepileptic drugs from the regimens of patients with intractable epilepsy. Ann Neurol 13: 320, 1983.