The Efficacy of Nonpharmacologic Treatment in Children with Pharmacoresistant Epilepsy

INTRODUCTION: Epilepsy is one of the most common chronic neurological disorders. Currently, a variety of older and newer AEDs are used in the treatment of epilepsy. Despite the use of these AEDs, about 20-30% of patients are not succesfully treated. This group of patients is called pharmacoresistant epilepsy patients. The frequency of seizures in patients with refractory epilepsy, adversely affects the quality of life and cognitive functions. Today, successful results are obtained from the epilepsy surgery. The purpose of this study was to evaluate the efficacy of epilepsy surgery (resective/VNS) in children with pharmacoresistant epilepsy. METHODS: This study was conducted among 62 children that were followed in Gazi University department of neurology long-term video EEG monitorization unit, with the diagnosis of epilepsy. They underwent the epilepsy surgery with the decision of the epilepsy surgery council. RESULTS: The study included 48 patients that underwent VNS treatment and 14 patients that underwent resective surgery. 31 patient were girls, 31 patients were boys, age at onset of seizures (range) was 35,2 +/- 37,0 months, age at epilepsy surgery was 11,9 +/- 3,8 years, time before epilepsy surgery was 8,7 +/- 4,1 years. 12 patients that underwent resective surgery were seizure free, 3 patients with VNS implantation were seizure free after surgery. Seizure reduction > % 90 was achieved in 1 patient, > % 75 in 7 patients and > % 50 in 19 patients. DISCUSSION and CONCLUSION: In conclusion resective surgery and VNS are effective treatment methods in children with pharmacoresistant epilepsy. VNS is relatively safe. In early period, resective epilepsy surgery for appropriate patients reduces the mortality. With appropriate patient and appropriate surgical method selection in patients with epilepsy, seizure control can be achieved largely. Until more effective therapies are developed, VNS and resective surgery will remain attractive alternatives for pharmacoresistant epilepsy.