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Journal of the Korean Child Neurology Society 2005;13(2):152-164.
Published online November 30, 2005.
Outcomes of Therapeutic Modalities for Intractable Childhood Epilepsy.
Hoon Chul Kang, Ji Won Kwon, Yong Soon Hwang, Heung Dong Kim, Sang Keun Park
1Department of Pediatrics, College of Medicine, Sanggye Paik Hospital, Inje University, Korea.
2Department of Neurosurgery, College of Medicine, Sanggye Paik Hospital, Inje University, Korea.
3Department of Epilepsy Center, College of Medicine, Sanggye Paik Hospital, Inje University, Korea.
4Department of Pediatrics, Handicapped Children's Research Institute, Brain Research Institute,College of Medicine, Severance Hospital, Yonsei University, Seoul, Korea.
Abstract
PURPOSE
This study sought to evaluate the clinical outcomes of various therapeutic modalities, including newly-developed anti-epileptic drugs (AEDs), prednisolone, ketogenic diet (KD) epilepsy surgery, and vagus nerve stimulation (VNS), in treating intractable childhood epilepsy. METHODS: Data of refractory epilepsy patients (n=297) treated from July 1995 through April 2003 at the epilepsy center of Sanggye Paik Hospital were retrospectively analyzed. RESULTS: Newly-developed AEDs were primarily prescribed to 290 patients, although only 20 patients (6.9%) maintained a seizure- free state. Of 138 patients for whom prednisolone was prescribed, 58 patients (42.0%) showed complete seizure controls while 41 patients experienced relapse. KD was attempted and evaluated at 12 months in 162 patients, at which time 74 (45.7%) remained on the diet and 68 (42.0%) showed seizure reduction of greater than 50%, including 37 (22.8%) who were completely seizure free. Epilepsy surgery was undergone in 38 patients, and Engel class I was identified in 25 (65.8%) patients. VNS was administered to five patients, only two of whom obtained a seizure reduction of more than 50%. RESULTS: Taken together, these findings suggest that considerable controls over intractable childhood epilepsy can be gained through KD and epilepsy surgery, whereas prednisolone treatment leads to somewhat more frequent relapses, and newly-developed AEDs are comparatively limited in their controls of refractory epilepsy.
Key Words: Intractable childhood epilepsy, Anti-epileptic drugs, Prednisolone, Ketogenic diet, Epilepsy surgery, Vagus nerve stimulation


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