Profile of intractable epilepsy in a tertiary referral center

This study was undertaken to find out the profile of intractable epilepsy (IE) in a tertiary referral centre. 100 patients (males 67; females 33) with IE attending the epilepsy clinic were evaluated. Detailed history, examination, investigations like EEG and CT scan and details regarding pharmacotherapy were analysed. The age of the patients ranged from 5 to 70 yrs (mean=23.2 yrs). Mean duration of seizures was 11.44 years. Commonest seizure type was partial seizures (74%). Amongst patients with generalised seizures (26%), 14% had multiple seizure types. The seizure frequency was 12.39 +/- 21.57 (mean +/- SD) per month. Fifty seven patients were in the symptomatic group with CNS infections being the leading cause (19%) of epilepsy. Fifty patients had one or more abnormal predictors of IE. There was no difference in the severity of epilepsy in patients with no abnormal feature when compared with patients having abnormal features. EEG was abnormal in 69% cases with background abnormality in 20% and focal abnormality in 36% cases. CT scan was abnormal in 41% cases with commonest abnormality being neurocysticercosis (11%) followed by gliosis (9%) and chronic infarct (9%). Sixty patients were receiving a combination of two drugs, 32 patients 3 drugs and 8 patients were on 4 drugs. There was no difference in seizure control in patients who were on 2 drugs or more than 2 drugs. Partial seizures were the commonest seizure type leading to IE; CNS infection being the leading aetiological factor. The presence or absence of predictors of intractability does not predict severity of epilepsy. Addition of third primary drug to existing combination only increases adverse effects without better control of seizures.