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Título

EVALUATION OF ACCIDENTS OCCURRENCE IN PATIENTS WITH TEMPORAL LOBE EPILEPSY: COMPARISON BETWEEN SURGICAL AND CLINICAL TREATMENTS

Resumo

Introduction: Patients with Epilepsy have a greater risk of accidents, which associates with high morbidity. The causes of frequent accidents are multifactorial, including falls without previous warning related to seizures, incapacity of using primitive protective reflexes because of the unawareness during seizures, drugs´ side effects (gait disturbances, disequilibrium and cognitive impairment). Mesial Temporal Lobe Epilepsy is recognized for being pharmacoresistant and, therefore, there will be a greater risk of accidents. Although the surgical treatment is recognized as effective in yielding seizure control, few studies have evaluated the impact of surgery on the frequency of accidents.

Objectives: To compare the frequency of accidents in patients with Temporal Lobe Epilepsy undergoing clinical and surgical treatments.

Methods: This is a retrospective, non-randomized study. Data were collected from medical records of individuals from outpatient Epilepsy Clinics of the University of Campinas (UNICAMP). Patients were divided into two groups: clinical and surgical. We searched for data related to falls, burnings, fractures, head trauma and car accidents. We performed chi-square and Fisher’s exact tests to analyze categorical variables and survival analysis (Kaplan Meier) to evaluate the time between the beginning of follow-up and the event´s occurrence. The comparison was made using Log Rank and Breslow tests.

Results: The clinical group included 242 patients, while the surgical group had 197 patients. Accidents were more frequent in the clinical group (37 [15.3%]) when compared to the surgical one (9 [4,6%]) [p<0,001]. During the follow up (median interval of 17 years [DP 6.78] in the clinical group; 8.6 years [DP 5.41] in the surgical group), 95.4% of the surgical patients were free of accidents, while in the clinical group, 84.7% [p=0.02]. Falls were more frequent in the clinical group (90 [37.2%]) than in the surgical one (15 [7.6%]) [p<0.001]. The survival analyses confirmed that over time, falls occurred in 36% of the clinical group compared to 8% in the surgical group [p<0,001], which can act as a risk factor for major accidents.

Discussion: Accidents can be frequent in people with epilepsy. Surgical treatment in pharmacoresistant Temporal Lobe Epilepsy may have an important role in accidents prevention. Therefore, surgery should be considered during clinical analyzes of these patients because of its significant impact on their quality of life.