title: Clinical phenotypes within non-surgical patients with mesial temporal lobe epilepsy caused by hippocampal sclerosis based on response to antiepileptic drugs.
abstract: OBJECTIVE
  To evaluate evolution and elucidate clinical phenotypes related to prognosis of patients with mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) treated exclusively with antiepileptic drugs (AED).
  
  
  METHODS
  Forty-seven out of 68 MTLE-HS patients treated between January 2005 and June 2010 were retrospectively studied for demographic, clinical and outcome data. The population was divided into drug-responder and drug-resistant patients; the latter was divided, according to the duration of the seizure-free periods along their evolution, into patients with at least one seizure-free period longer than one year and those with shorter periods. Variables were compared between drug-responders vs drug-resistants and drug-resistants with long seizure-free periods vs drug-resistants without it.
  
  
  RESULTS
  There were 7 (15%) drug-responders, 39 (83%) drug-resistants and 1 patient (2%) with an undetermined response. Eighteen (46%) drug-resistant individuals had seizure-free periods longer than one year, with mean duration of 46 months (3.8 years). Since no factor was statistically associated with long seizure-free period within drug-resistants, we can clinically distinguish two phenotypes: women with left HS and late onset of seizures, with poor prognosis, and men with right HS and earlier appearance of seizures, attaining a better outcome. Twenty out of 47 (42.5%) patients followed an intermittent pattern of epilepsy.
  
  
  CONCLUSIONS
  Non-surgical MTLE-HS drug-resistant patients can achieve long seizure-free periods with AED, but relapses are common. Female gender, left or bilateral lesion and later onset of seizures seem to be bad prognosis factors within MTLE-HS drug-resistant patients.
authors.affiliation: Department of Neurology and Neurosurgery, Clinica Universidad de Navarra, Pamplona, Spain. agomezi@unav.es
authors.forename: Asier
authors.initials: A
authors.lastname: Gomez-Ibañez
authors.forename: Carmen
authors.initials: C
authors.lastname: Gasca-Salas
authors.forename: Elena
authors.initials: E
authors.lastname: Urrestarazu
authors.forename: Cesar
authors.initials: C
authors.lastname: Viteri
mesh_terms: D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D004833:Epilepsy, Temporal Lobe / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D012189:Retrospective Studies; D012598:Sclerosis / Q000150:complications / Q000188:drug therapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants