title: [Characteristics of patients with refractory epilepsy attended in a tertiary referral center in Costa Rica].
abstract: BACKGROUND
  Thirty percent of patients with epilepsy have recurrent seizures, representing fifteen million people in the world. This population has been scarcely described.
  
  
  OBJECTIVE
  To characterize sociodemographic and clinically the patients diagnosed with refractory epilepsy in a tertiary referral hospital of the Costa Rican social security.
  
  
  METHODS
  This study presents an analysis of all cases of refractory epilepsy evaluated at the epilepsy unit of San Juan de Dios Hospital from August, 2012 to October, 2014.
  
  
  RESULTS
  Clinical records of 91 patients were studied; patients with psychogenic seizures were analyzed separately. The mean age of onset was 13.1 ± 11.1 years, secondary generalized seizures were the predominant type (81.3%), the most frequent etiology was mesial temporal sclerosis (48.3%) and the majority had normal neurological exams and normal or low neuropsychological assessments. Around half (48.8%) of the patients had been medicated with a range of 4-6 antiepileptic drugs, being lamotrigine, carbamazepine, valproic acid and phenytoin the most prescribed. Treatment optimization, neurosurgery, and further analysis were standard recommendations. Sociodemographic characteristics, patient management, and antiepileptic drugs used are similar to the described in other latitudes. Differences between the age of onset and gender; seizure frequency and gender; age of onset and failed treatments and time of evolution of the disease and employment were observed. The percentage and characteristics of recurrent seizures of psychogenic nature found are comparable to other refractory epilepsy studies.
  
  
  CONCLUSIONS
  Sociodemographic characteristics, management of patients, antiepileptic drugs used and the differences observed are similar to those previously described.
authors.affiliation: Hospital San Juan de Dios, San Jose, Costa Rica.
authors.forename: A
authors.initials: A
authors.lastname: Sanabria-Castro
authors.affiliation: Hospital San Juan de Dios, San Jose, Costa Rica.
authors.forename: F
authors.initials: F
authors.lastname: Henriquez-Varela
authors.affiliation: Hospital San Juan de Dios, San Jose, Costa Rica.
authors.forename: S
authors.initials: S
authors.lastname: Lara-Maier
authors.affiliation: Hospital San Juan de Dios, San Jose, Costa Rica.
authors.forename: C
authors.initials: C
authors.lastname: Monge-Bonilla
authors.affiliation: Hospital San Juan de Dios, San Jose, Costa Rica.
authors.forename: M
authors.initials: M
authors.lastname: Sittenfeld-Appel
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003364:Costa Rica / Q000453:epidemiology; D000069279:Drug Resistant Epilepsy / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000927:Anticonvulsants