Drug-resistant epilepsies in children: clinical case

Abstract

Background: Refractory epilepsy is estimated to affect 10-20% of children diagnosed with epilepsy. The impact of drug-resistant epilepsy can have a profound effect on education abilities, cognitive functioning presiding over intellectual disabilities, psychiatric comorbidity, physical injury, sudden death in epilepsy and poor quality of life. Various predictors of drug resistance have been identified; however, the exact prediction factor remains a challenge. The aim of the study is to present a case of drug-resistant epilepsy case with polymorphic seizures and various electroencephalographic video patterns. Material and methods: observational study of the clinical case of drug resistance in children. Results: The clinical case of the child with drug-resistant epilepsy, manifested by polymorphism crisis was confirmed by the video EEG monitoring. The 3.0T brain MRI epilepsy protocol revealed the structural thinning of the white matter of the cerebral hemispheres, periventricular cystic defects and diffuse periventricular gliosis changes with diffuse enlargement of the ventricular and cisternae cerebral systems and bilateral reduction of hippocampal areas, atrophic type. Treatment of the child included ACTH, Valproic acid, Levetiracetam, Perampanel, but freedom from seizures was not achieved. The prognosis remained reserved. Conclusions: despite the antiepileptic drug treatment performed according to ILAE guidelines, the child continues to develop polymorphic epileptic seizures. The drug-resistant epilepsy is dependent on the child’s age, type of seizures, electroencephalographic appearance, the presence of structural changes in the brain.