Análise prospectiva de pródromos de crises epilépticas em pacientes com epilepsias refratárias

Abstract

Background: Anticipation of epileptic seizures may allow acute interventions to reduce physical and psychosocial harm associated with unexpected attacks. Recent data suggest that electrical abnormalities evolve during many hours before a seizure and these may potentially be clinically identified as seizure prodromes. Objectives: We aimed to determine, in an objective and verifiable fashion, the types, prevalence, sensitivity, specificity and predictive value of seizure prodromes in patients with refractory partial epilepsies, as well to study the clinical and psychiatric correlates of these premonitory symptoms. Methods: We studied 55 adult patients who had at least one focal seizure recorded during of video-EEG monitoring. Patients noted any symptoms they associated with impending seizures and that information was complemented daily by entering actual seizure occurrence according to video- EEG. Detailed clinical and psychiatric data were then correlated with the occurrence of prodromes. Results: Thirty-six patients (65%) reported prodromal symptoms, a median of 12 hours before seizures. Half were related to mood changes. Female sex, higher baseline seizure frequency and a history of more severe depressive disorders independently correlated with the occurrence of prodromes. Mean specificity and PPV slightly above 80% contrasted with sensitivity and NPV slightly below 60%. Conclusion: Seizure prodromes in the context of presurgical evaluation are common in adult patients with medically refractory seizures and should be discussed with patients as a means to anticipate seizures and thus minimize harm. Development of acute interventions to prevent seizures at the time of prodromes is an attractive possibility.