Predictive factors for drug resistance in adult lesional epilepsy: Evidence from a cross-sectional study

Şeyma Aykaç; Birgül Dere; Abdullah Arı; Rasim Tunçel; Cenk Eraslan; İbrahim Aydoğdu

doi:10.19161/etd.1773677

TR EN

Yetişkin lezyonel epilepside ilaç direncini öngören faktörler: Kesitsel bir çalışmadan kanıtlar

Öz

Amaç: Lezyonel epilepsi, epilepsi olgularının önemli bir kısmını oluşturmakta olup tedavi yanıtı, lezyon tipi ve klinik özelliklere göre değişmektedir. Bu olgularda ilaç tedavisine dirence etki eden faktörlerin belirlenmesi, hasta yönetimi ve cerrahi operasyonların planlanmasında gereklidir. Bu çalışmanın amacı, erişkin lezyonel epilepsi hastalarında klinik, radyolojik ve elektroensefalografi (EEG) bulgularının ilaç tedavisinde elde edilen yanıt ile ilişkisini belirlemektir. Gereç ve Yöntem: MRG (magnetik rezonans görüntüleme) ile doğrulanmış yapısal lezyonu bulunan, ≥18 yaşında ve en az bir yıl süreyle antiepileptik ilaç (AEİ) tedavisi almış hastalar geriye dönük olarak incelendi. Psikojenik non-epileptik nöbet, akut semptomatik nöbet, tedaviye uyumsuzluk ve önceki epilepsi cerrahisi öyküsü olan hastalar dışlandı. Demografik veriler, nöbet tipi, AEİ rejimi, MRG lezyon özellikleri ve interiktal EEG bulguları kaydedildi. İlaç direnci, iki uygun ve iyi tolere edilen AEİ rejiminin başarısızlığı olarak tanımlandı. Bulgular: Toplam 96 hasta (41 erkek, 45 kadın; ortalama yaş: 42 yıl) dahil edildi. En sık görülen lezyon ensefalomalazi (%43) olup, bunu tümörler (%26), kortikal gelişim malformasyonları (KGM) (%8), kistik lezyonlar (%6), vasküler malformasyonlar (%6) ve mezial temporal skleroz (%5) izledi. İlaç direnci %26 oranında görüldü; KGM grubunda bu oran %62 ile anlamlı olarak daha yüksekti (p = 0,026). Cinsiyet, nöbet başlangıç yaşı, jeneralize motor nöbet varlığı, EEG anormallikleri ve lezyon lateralitesi ile ilaç direnci arasında anlamlı ilişki bulunmadı. Sonuç: KGM, erişkin lezyonel epilepsi hastalarında ilaç direnci ile güçlü şekilde ilişkilidir. Bu hastaların erken dönemde tanınması, cerrahi değerlendirme sürecinin hızlandırılmasını ve nöbet kontrolünün iyileştirilmesini sağlayabilir.

Anahtar Kelimeler

Predictive factors for drug resistance in adult lesional epilepsy: Evidence from a cross-sectional study

Abstract

Aim: Lesional epilepsy accounts for a substantial proportion of epilepsy cases, with treatment outcomes varying according to lesion type. Identifying predictors of drug resistance is essential to guide management and surgical planning. This study evaluated clinical, radiological, and electroencephalographic (EEG) predictors of treatment response in adults with lesional epilepsy. Materials and Methods: Medical records of patients ≥18 years with MRI (magnetic resonance imaging)-confirmed structural lesions and ≥1 year of antiepileptic drug (AED) therapy were retrospectively reviewed. Patients with psychogenic non-epileptic seizures, acute symptomatic seizures, non-adherence, or prior epilepsy surgery were excluded. Data included demographics, seizure type, AED regimen, MRI lesion features, and interictal EEG findings. Drug resistance was defined as failure of two appropriately chosen, well-tolerated AED regimens. Results: Ninety-six patients (41 males, 45 females; mean age 42 years) were included. Encephalomalacia was the most frequent lesion (43%), followed by tumors (26%), malformations of cortical development (MCD) (8%), cystic lesions (6%), vascular malformations (6%), and mesial temporal sclerosis (5%). Drug resistance occurred in 26% of cases, with MCD showing the highest rate (62%, p = 0.026). Gender, age at onset, generalized motor seizures, EEG abnormalities, and lesion laterality were not significantly associated with drug resistance. Conclusion: MCD is strongly associated with AED resistance in adults with lesional epilepsy, while other lesion types tend to respond more favorably. Early recognition of high-risk patients may facilitate timely surgical evaluation and improve seizure control outcomes.

Keywords

References

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Details

Primary Language

English

Subjects

Central Nervous System , Neurology and Neuromuscular Diseases

Journal Section

Research Article

Authors

Şeyma Aykaç ^*
0000-0003-3994-0019
Türkiye

Birgül Dere
0000-0002-0565-4922
Türkiye

Abdullah Arı
0009-0006-1995-210X
Türkiye

Rasim Tunçel
0000-0001-7394-3366
Türkiye

Cenk Eraslan
0000-0002-5762-6149
Türkiye

İbrahim Aydoğdu
0000-0001-7209-7161
Türkiye

Publication Date

December 8, 2025

Submission Date

August 29, 2025

Acceptance Date

September 9, 2025

Published in Issue

Year 2025 Volume: 64 Number: 4

DOI

https://doi.org/10.19161/etd.1773677

IZ

https://izlik.org/JA73JX88UN

Cite

RIS / Bibtex

Vancouver

1.Şeyma Aykaç, Birgül Dere, Abdullah Arı, Rasim Tunçel, Cenk Eraslan, İbrahim Aydoğdu. Predictive factors for drug resistance in adult lesional epilepsy: Evidence from a cross-sectional study. EJM. 2025 Dec. 1;64(4):701-8. doi:10.19161/etd.1773677