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Original ArticleOpen Access
The Prevalence and Risk Factors of Refractory Partial Seizure Thai Patients at Prasat Neurological Institute
Towanabut S 
,
Rungreangyingyod L ,
Suthisisang C
,
Rungreangyingyod L ,
Suthisisang C The prevalence of refractory partial seizure Thai patients at Prasat Neurological Institute
was retrospectively from patient charts from January 1995 - December 1996 and further
prospectively analysied. All epileptic patients were screened by direct questions regarding
the anti-epileptic drugs (AEDs) regimen, the frequency, nature of seizure attacks and risk
factors of seizure. The criteria of clinical refractory partial seizure was defined as partial seizure
which cannot be controlled by a combination of at least two AEDs for four weeks. The results
were 3,018 cases of total epileptic patients out of 300,008 visits. These were classified as 2,802
cases of generalized seizures (92. 8% ), 184 cases of partial seizures (6.1% ), and 32 cases of
unclassified seizures ( 1.1% ). In the partial seizures group, the number of clinical refractory
partial seizures was found to be 48 cases (26.1% of partial seizure). We found that the major
risk factor of refractory partial seizures was lack of therapeutic AEDs blood level monitoring
(64.5% of cases) and the other risk factors were lack of compliance, loss of follow-up but
continued medication, concomitant medication, and improper drug storage. AEDs dosage
was adjusted until the blood levels were in the therapeutic range, and correction of other risk
factors and patient counseling was given. The number of true refractory partial seizures was
reduced to 10 cases (5.4% of partial seizure). This procedure revealed that AED blood level
monitoring and correction of other risk factors were essential in controlling seizure frequency.
Thus, the prevalence of true refractory partial seizure in our study was 3.3 cases of
refractory partial seizure per 1,000 cases of the seizure population. We recommend that AEDs
blood level monitoring and exclusion of other risk factors should be added to the criteria
for the definition of refractory partial seizures. This criteria should be applied when considering
the use of new AEDs as an add-on therapy in refractory Thai patients.
was retrospectively from patient charts from January 1995 - December 1996 and further
prospectively analysied. All epileptic patients were screened by direct questions regarding
the anti-epileptic drugs (AEDs) regimen, the frequency, nature of seizure attacks and risk
factors of seizure. The criteria of clinical refractory partial seizure was defined as partial seizure
which cannot be controlled by a combination of at least two AEDs for four weeks. The results
were 3,018 cases of total epileptic patients out of 300,008 visits. These were classified as 2,802
cases of generalized seizures (92. 8% ), 184 cases of partial seizures (6.1% ), and 32 cases of
unclassified seizures ( 1.1% ). In the partial seizures group, the number of clinical refractory
partial seizures was found to be 48 cases (26.1% of partial seizure). We found that the major
risk factor of refractory partial seizures was lack of therapeutic AEDs blood level monitoring
(64.5% of cases) and the other risk factors were lack of compliance, loss of follow-up but
continued medication, concomitant medication, and improper drug storage. AEDs dosage
was adjusted until the blood levels were in the therapeutic range, and correction of other risk
factors and patient counseling was given. The number of true refractory partial seizures was
reduced to 10 cases (5.4% of partial seizure). This procedure revealed that AED blood level
monitoring and correction of other risk factors were essential in controlling seizure frequency.
Thus, the prevalence of true refractory partial seizure in our study was 3.3 cases of
refractory partial seizure per 1,000 cases of the seizure population. We recommend that AEDs
blood level monitoring and exclusion of other risk factors should be added to the criteria
for the definition of refractory partial seizures. This criteria should be applied when considering
the use of new AEDs as an add-on therapy in refractory Thai patients.
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