Some Considerations in the Postsurgical Clinical Evolution of Patients with Refractory Temporal Lobe Epilepsy

Juan Enrique Bender del Busto

Philosopher Doctor, Second Degree Specialist in Neurology, Full Professor and Researcher, International Center of Neurological Restoration (CIREN), Havana, Cuba

*Correspondence to: Dr. Juan Enrique Bender del Busto, Philosopher Doctor, Second Degree Specialist in Neurology, Full Professor and Researcher, International Center of Neurological Restoration (CIREN), Havana, Cuba.

Copyright © 2019 Dr. Juan Enrique Bender del Busto. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Epilepsy is a global public health problem that requires an adequate response. According to reports from the World Health Organization (WHO), an estimated 50 to 69 million people suffer from this disease, the majority living in developing countries, where the quality of life is worse and the incidence of infections of the Central Nervous System (CNS) is greater [1].

Epilepsy, in turn, is considered as old as humanity itself and one of the most frequent disorders of the Central Nervous System (CNS), for some the second neurological disease [2].

It can be asserted that it affects 1-2% of the population. Up to 70% of people with this disease could lead a normal life if treated properly, but for the vast majority of patients this is not the case.

It is currently considered by the International League Against Epilepsy (ILAE) and the International Office for Epilepsy (IBE), as a disease and not a disorder.

The annual incidence of unprovoked epileptic seizures is 33-198 per 100,000 inhabitants per year, and the incidence of epilepsy is 23 to 190 per 100,000 inhabitants per year [3].

The incidence in children is higher and even more variable, from 25 to 840 per 100,000 inhabitants per year, most of the differences are explained by the diverse populations at risk and by the design of the study [4].

The overall prevalence varies from 2.7 to 41 per 1000 inhabitants, although in most reports the rate of active epilepsy is in the range of 4-8 per 1000 inhabitants [5-8].

International statistics show annual mortality rates of 2.1 per 100 000 inhabitants per year, varying from 1 to 8 in different countries.

Most authors agree that between 70-80% of all epileptics are controlled with medical treatment and 20- 30% are chronic refractory, considered a chronic medically uncontrollable epilepsy. In 5-10% these patients are candidates for surgery.

Drug resistance is an important problem for the patient, with devastating consequences, including persistence of seizures and morbidity derived from epilepsy, medication, social isolation, unemployment and decreased quality of life. It also describes an increase in the risk of unexplained sudden death, as well as an important health cost resulting from the use of new and multiple medications and a greater need for health care.

Intractable chronic epilepsy by antiepileptic medication carries a poor prognosis, with a mortality rate of 1/200 inhabitants / year as a direct consequence of the seizures.

Taking into account the above, in accordance with the guidelines published in our country [9], the Epilepsy Surgery Project at International Center of Neurological Restoration of Havana, Cuba, carried out research aimed at the study of refractory epilepsy, in its first stages, of the temporal lobe, and the postsurgical evolution of the lobectomized patients was studied in different periods.

Twenty patients underwent adjusted temporal lobectomy were evaluated between 2002 and 2007. In the same, the adjusted temporal lobectomy showed a significant decrease in the number of epileptic seizures subsequent to the surgical procedure, with a crisis-free time of 2 years and an evolution according to the Engel Scale of 55% of patients free of crisis. Quality of life increased considerably after the operation [10,11].

Subsequently, a study was conducted during 2010 and 2012 in 22 patients. The adjusted temporal lobectomy demonstrated a significant decrease in the number of epileptic seizures subsequent to the surgical procedure, as well as their severity and a favorable evolution according to the Engel Scale. It was also specified that epileptic seizures may reappear during the second and third postoperative years [12].

A third study was conducted in 30 patients with similar surgical intervention between 2002 and 2013, in order to determine the prognostic factors. It was concluded that adjusted temporal lobectomy achieves a reduction in the number of seizures in patients with refractory epilepsy, as well as an improvement in quality of life, but additional studies are required in relation to prognostic factors, as the results are contradictory [13-16].

Finally, in a fourth study post-surgical evolution was done in 24 patients, with more than 10 years of lobectomy. The postsurgical clinical evolution in them showed a stable long-term behaviour and after 2 years of surgery most patients had a higher probability of recurrence of seizures.

The presence of some signs of lateralization were predictors for the crisis-free condition in the long-term postoperative evolution [17-25].

In general, in the studies carried out, the adjusted temporal lobectomy showed a reduction in epileptic seizures, in intensity and frequency, with an improvement in the quality of life of affected patients and the possibility of the presence of seizures after the two years of surgical intervention. Studies of predisposing factors are still contradictory and further research is needed, which coincides with several authors.

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